Equipped MD Shipping Form

Desired Delivery Time Frame: *

ASAPOTHER (Add Details Below)

If Selecting Other Please Describe Below:*

Be Sure To Include Delivery Dates

If your facility requires specific days or times for delivery, please list here:

Failure To Do So Can Result In Additional Shipping Charges

Facility Name:*

Shipping Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

The contact person needs to be onsite to receive delivery and available by phone to coordinate with the freight carrier if needed.

Contact Person:*

First NameLast Name

Contact Number:*

Please enter a valid phone number.

Contact Email: *

example@example.com

If an alternate Contact is needed (Not Required but reccomended)

Alternate Name:

First NameLast Name

Alternate Phone Number:

Please enter a valid phone number.

Alternate Email:

example@example.com

We understand the importance of timely and cost-effective shipping solutions to meet the unique needs of your business. To enhance your shipping experience, we offer a range of services tailored to accommodate various timelines and budgets. Please check if you will be needing the following services for your equipment, please note that some of these may be an additional charge.

Do you need any of the following:*

White Glove Delivery Service (unpacking and removal of debris)Call AheadAppointment For DeliveryInside Delivery

Is your facility tractor trailer (53 ft long) accessible?*

If a facility is deemed inaccessible upon arrival, customers will be billed for any attempt and/or labor charges in addition to quoted costs.

Do you have a loading dock?*

What floor will the equipment be delivered to in your facility?*

If there is no freight elevator, do you have a standard elevator? If so, what are the dimensions?*

What are the dimensions of all the door(s) the equipment needs to go through?*

Additional information we should know:

SHIPPING TERMS: PLEASE READ CAREFULLY

Exact delivery dates are not guaranteed, but we will do our best to get your items to you in the time frame needed, however due to the nature of shipping with a 3rd party and weather conditions shipping times can vary. PLEASE DO NOT SCHEDULE PATIENTS UNTIL RECIEPT OF EQUIPMENT, as we will not be held liable for shipping companies missing delivery dates.

Customers MUST remove all plastic wrap and inspect the equipment upon delivery. Any damage must be noted on the signed bill of lading at the time of delivery. If the equipment is damaged and the damage is not noted on the bill of lading, insurance may not cover the damages incurred during shipping. Please notify us immediately if damages have occurred.

Please note if you are a rental customer: If you are renting this equipment, please save any and all packing materials. This will save you money when the unit is ready to be shipped back. If packing materials are unable to be saved or stored, the equipment will have to be shipped back as loose items or packaged upon pick up by the carrier and extra shipping charges will occur, which will be billed to you upon the final return invoice.

Name Of Person Completing Form:*

First NameLast Name

The above information is accurate to the best of my knowledge. Should any of the information be deemed inaccurate at the time of delivery, we (the customer) will be responsible for any additional expenses which may occur.

Signature*