Account Name*
Medline Account Number*
Address*
Contact at Account*
Phone*
Email*
Is your pump Leased, Rented or Owned?* Leased Rented Owned
Please provide the purchase order number:
Total number of pumps being returned/repaired? (10 pump max)* The serial number boxes will show below once this value is filled in. If you have more than 10 pumps, please add those additional serial numbers to the "Additional Comments" section at the end of the form”
Pump 1 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 2 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 3 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 4 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 5 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 6 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 7 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 8 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 9 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Pump 10 Leased Pump Type SELECT OST1000L - SENTINEL FEEDING PUMP, LEASE DOY199235L - COMPAT FEEDING PUMP, LEASE DOY199255L - COMPAT DUALFLO FEEDING PUMP, LEASE ENT199235L - ENTRAFLO FEEDING PUMP, LEASE ENT199255L - ENTRAFLO H20 FEEDING PUMP, LEASE
Rented Pump Type SELECT OST1000RNT - SENTINEL FEEDING PUMP, RENTAL DOY199235RNT - COMPAT FEEDING PUMP, RENTAL DOY199255RNT - COMPAT DUALFLO FEEDING PUMP, RENTAL ENT199235RNT - ENTRAFLO FEEDING PUMP, RENTAL ENT199255RNT - ENTRAFLO H20 FEEDING PUMP, RENTAL
Owned Pump Type SELECT OST1000 - SENTINEL FEEDING PUMP,PURCHASE DOY199235 - COMPAT FEEDING PUMP,PURCHASE DOY199255 - COMPAT FEEDING PUMP,PURCHASE ENT199255 - ENTRAFLO H20 FEEDING PUMP, PURCHASE ENT199235 - ENTRAFLO FEEDING PUMP, PURCHASE
Serial Number:
Service: Sending pump for servicing Returning pump, no longer needed Rebranding at $150 per unit Quality Complaint
Describe Service Issue
Additional Comments Additional Serial numbers can be entered here if necessary.
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