By completing this from I authorize E4D Technologies to pre-authorize the amount indicated for replacement equipment and charge the credit card according to the terms outlined below.

Terms and Conditions for Replacement Equipment:

  • If the current equipment is not returned within 14 business days of receipt; the following charges will be assessed:
    • SCANNER ONLY- $6,000 (USD)*
    • LAPTOP ONLY – $2,000 (USD)
    • SCANNER & LAPTOP – $8,000 (USD)
  • Equipment must be returned using the provided label and packaging.
*Includes Classic, NEVO, and PlanScan scanners.
  • Business Information

  • Business Phone

  • Equipment Replacement

  • Please select the appropriate product.
  • $0.00

  • Credit Card Information

  • The billing address of this card must match the credit card billing address given above. Otherwise the transaction will be declined and may result having a hold placed on your account by your bank.
  • American Express

  • By selecting "I agree to the terms" and clicking "Submit" on this form I authorize E4D Technologies to pre-authorize and charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

    By clicking "submit" on this form you agree to all terms and conditions outlined above and acknowledge that you have downloaded and read the E4D Technologies - Business Associate Agreement.

    Ensure all information is correctly entered and an available credit line for the amount above before submitting this form. Any errors may result in additional holds to your credit card account, as regulated by your credit card company. When submitting this form a credit pre-authorization will appear on your account for the amount indicated above. These pre-authorizations, also known as holds, typically remain on the account 4-5 business days depending on your credit card agreement. In rare occasions declined transactions may appear as a hold on your credit account. Please contact your credit card company with any questions regarding holds or pending transactions.

    Note: Your card will only be charged if your current equipment is not returned to E4D Technologies within 14 business days in the provided package.
  • This field is for validation purposes and should be left unchanged.

After submitting this form do not refresh the browser or click the back button. It is best to close the browser to prevent recurrent holds.