Currie Medical Return Goods Authorization (“RGA”) Form

All pump returns, regardless of the reason for the return, require a unique RGA number. Upon submission of this RGA request, and a review/acceptance by a Currie representative, your RGA number, along with Currie’s repair center shipping address and packing instructions, will be issued via email using the email address entered on this form.

Company Name

Customer ID #

How many pumps are you returning?

Serial Number of each pump being returned *

Reason for return

If requesting repair, briefly describe the defect associated with each pump. Please list each serial number.

Pump Model

Name

Phone Number

Where should we SHIP the repaired or replacement pumps? To whose ATTN?

Special Instructions or Details?

Please check the box to indicate you accept our Terms & Conditions.