RGA Request - J2S Medical

We are here to service your needs, please complete the form below, if you have any questions give us a call at 844-Dial-J2S.

*Company Name

Address

*City

*State

Zip Code

*Contact Name

*Email Address

*Phone Number

Return Authorization #

J2S Sales Representative

Market Segment

Labor

Contact With Estimate?

Customer PO#

Preferred Shipping Method

Please complete the following information on the equipment to be returned

*Device OEM/Model

*Description of Problem

*Serial Number

Warranty?

Add Another Piece of Equipment Notes