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Contact Details
Company Name
Point of contact
Address
City
State
Country
Postal Code
Phone Number
Cell phone
Email
Preferred Contact Method
Cell
Phone
Text
Email
Equipment Information
Patient Transport Equipment
Stretcher
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Stairchair
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Lockdown/Track system
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Wheelchair
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Other
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Wheelchair Lift
Power
Manual
Quantity
1
2
3
4
5
S/N (Enter multiple SN separated by comma)
Submit
$75 /
One time Cost
One time video diagnosis
Customer pays for parts + shipping
Add:
Remote video Installation guidance (live), $45
Basic
Timely Response (to Claim)
Remote Diagnostic
Phone and Video Tech support
Unlimited Claims
Free Parts & Shipping
Technical Video Installation Support:
$45 Per Session
On-site support available
Preventative Maintenance Procedures
Annual Remote Maintenance
Schedule Service and Access Records Anytime
Premium
Timely Response (to Claim)
Remote Diagnostic
Phone and Video Tech support
Unlimited Claims
Free Parts & Shipping
Technical Video Installation Support:
$45 Per Session
On-site support available
Preventative Maintenance Procedures
Annual Remote Maintenance
Schedule Service and Access Records Anytime
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