poc_repair

Name*

First Name

Last Name

Phone*

Email*

How did you hear about us?*

Address (Your device will be returned to this address)*

Address Line 1

Address Line 2

City

State

ZIP Code

Please select the model you will be sending in:*

Select Equipment Model

Is your Portable Oxygen Concentrator (POC) under warranty?*

Equipment Serial Number*

Please describe the problem you are having with your POC.

Cost

Charges 400$ to validate credit card

$ 400.00

Quantity:

Credit Card*

Is the Billing Address the same as the Shipping Address listed above?*

Yes No

Billing Address

Address Line 1

Address Line 2

City

State

ZIP Code

Terms & Condition: Services Offered

www.myportableoxygenrepair.com performs warranty and out-of-warranty repairs for portable oxygen concentrator (POC) devices. Our technicians are certified by the manufacturer to repair the devices utilizing the manufacturer’s software for testing.
Our services come with a 90-day warranty on all parts used in our original repair.
Our standard turnaround time is 3-5 business days from the time of receipt.
When we receive your form we will send you a tracking number and the address of the closest service center to send your machine to us.

Terms & Condition: Pricing for Services Offered

Please note that a $400 hold will be placed on your card as a placeholder only. No charges will be put against the card until a written estimate is provided to you and approved.
We perform all services with a flat labor rate of $129 per service, no matter whether the device is under warranty or not.
Parts will be added as needed. The estimate sent to you prior to repair will show the cost of each part used. Parts covered under the manufacturer’s warranty will not be charged to the client.
Shop supplies are generally needed to complete the service (elastomers, tubing, cleaning materials, etc.). To account for this, $4.95 will be added to your estimate to cover those materials.
Our flat rate shipping charge is $30. This covers the cost of the box, packaging, and shipping.
Taxes, Shipping and Handling, and a 3% credit card processing fee will be added to the Service Estimate value when processing your payment.

Terms and Conditions*

I agree to My POC Repair Terms & Conditions

Campaign Source

This hidden field has been added by Attribution to CRM Plugin to store Campaign Source in this Form's submission table

Campaign Medium

This hidden field has been added by Attribution to CRM Plugin to store Campaign Medium in this Form's submission table

Campaign Term

This hidden field has been added by Attribution to CRM Plugin to store Campaign Term in this Form's submission table

Campaign Content

This hidden field has been added by Attribution to CRM Plugin to store Campaign Content in this Form's submission table

Campaign Name

This hidden field has been added by Attribution to CRM Plugin to store Campaign Name in this Form's submission table

GCLID (Google Click Identifier)

This hidden field has been added by Attribution to CRM Plugin to store GCLID (Google Click Identifier) in this Form's submission table

Portable Oxygen Concentrator Repair Form