HME DEALER FORMS

Ohio Service Center:
HME Dealer Equipment Packing List

PLEASE READ THESE INSTRUCTIONS:

Complete this packing slip and insert into the box of the unit(s) you are sending in for repair. If you are sending in more than one unit, you can add fields below for each unit. Only one copy of this form is required.

• If you are on a regular Repair Authority route , please attach this form to the equipment AND email logistics@repairauthority.com to schedule a pickup. If you are shipping in equipment, please enclose this form in the package and ship to the address below.

• If a purchase order number (PO#) is necessary, please complete that information on the form as well. A Return Authorization Number (RA#) is NOT required.

• After clicking "Submit" you will receive a link to download and print this completed form.

• IF YOU ARE A PATIENT, PLEASE UTILIZE THESE FORMS INSTEAD TO PLACE YOUR REPAIR ORDER.

Repair Authority Headquarters/Cleveland Service Center
21973 Commerce Parkway, Suite A
Strongsville, OH 44149
Questions: dealer@repairauthority.com or 888.828.1872

If you are not already a Repair Authority customer you must apply before sending in equipment.