TRAVEL LOANER AGREEMENT
In order for Medtronic Diabetes to provide you with a loaner insulin pump, please complete the information below and then click on the "submit" button at least two weeks prior to your scheduled departure. In your shipment, you will receive instructions for returning the insulin pump. Please be aware that the travel loaner insulin pump remains the property of Medtronic Diabetes. To help cover the cost of our loaner program, we must charge you a US $50 fee for shipping and handling. If the loaner pump is lost, stolen, or damaged, we must ask you to be responsible for the replacement cost of US $3,600.
Please understand that if we do not receive the loaner pump within two weeks of your estimated return date (not to exceed 90 days from the date of departure), we must apply the replacement cost charge of US $3,600 to your credit card (in either a lump sum or monthly installments, at our discretion).
By submitting this form, you are granting Medtronic MiniMed, Inc. ("Medtronic") permission to add your contact information to its database for sending you additional information and communications related to Medtronic products and therapies. You may revoke this permission at any time by sending a request in writing to: Medtronic MiniMed, Inc. c/o Customer Support, 18000 Devonshire Street, Northridge, CA 91325-1219
Medtronic respects and upholds the confidentiality of your personal information. We will not share your personal information with any third-parties, except as otherwise noted in our Website.