Drive Oxygen Concentrator RMA Request Form

Model Number(Required)

Please enter the model number

Serial Number(Required)

Please enter the device serial number

Hours(Required)

Please upload photo of hour meter

Drop files here or

Accepted file types: jpg, png, bmp, gif, pdf, jpeg, Max. file size: 128 MB.

Were any off-brand filters being used?(Required)

(Select "Yes" if any non-Drive filters were used)

Description of the defect or reason for return:(Required)

Was there an injury?(Required)

Did the user seek medical attention?(Required)

Resolution (Do you need parts, replacement, credit, etc.?):(Required)

Business Name:

Contact Name and information:

Your Email Address(Required)

Please enter your email address

Enter Email Confirm Email

Your Phone Number(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Attach photo/s of the defect/damage:(Required)

Drop files here or

Accepted file types: jpg, png, pdf, bmp, gif, jpeg, Max. file size: 128 MB.

CAPTCHA

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Contact