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About Us

Pumps

Medical Furniture

Accessories

Rental/Repair/Sell

Customer Service

Welcome to the new United Infusion Medical RMA Form!

Thank you for your continued business, we hope the new features make your visit more enjoyable!

RMA

*Required

RMA Details

RMA Type *

Device Quantity *

Pre-approved Cost (Per Device)

Shipping Label Quantity *

Request Local KC/LA Pickup Instead?

Contact

Company *

Phone Number

Email *

First Name *

Last Name *

RMA Devices

*Required

Devices

Update Device Quantity

RMA Shipping

*Required

Ship From Address

Address *

Address 2

City *

State *

Zip Code *

Country *

RMA Shipping

*Required

Ship From Address

Address *

Address 2

City *

State *

Zip Code *

Country *

Billing address

Address *

Address 2

City *

State *

Zip Code *

Country *

Return address (after service)

Address *

Address 2

City *

State *

Zip Code *

Country *

RMA Review

*Required

Devices

Issue / Reason *

Original Issue

Additional Notes

Manufacturer

Model*

SN *

Asset Tag / Control #

Issue / Reason *

Original Issue

Additional Notes

Manufacturer

Model*

SN *

Asset Tag / Control #

Issue / Reason *

Original Issue

Additional Notes

Manufacturer

Model*

SN *

Asset Tag / Control #

Issue / Reason *

Original Issue

Additional Notes