Medical Equipment - Request Form

Needing medical equipment? Request any equipment that you need, and we will get you it as soon as possible.

Location for Pickup: Apex, NC

Contact Information: bilslocker@gmail.com

Email

Full Name

Phone

How long do you need it? Please fill in a date by which you will be able to return the equipment. (This helps us support our high demand equipment - Thank you)

Anything else you would like us to know?