Order Submission Form

US and Canada - B2B Partner Order Submission Form

Thank you for choosing Inogen and using our online Order Submission Form. Please complete all required fields to ensure we can process your order promptly and accurately. Once all information has been entered, please review and submit.

This form is intended for use only by Inogen US and Canada B2B HME Partners who have an account established
If you do not know your customer account numbers, you should be able to locate this information in your last invoice or a Sales order acknowledgment sent by Inogen
If you wish to set up a customer account, please email our sales support group via _b2bsalessupport@inogen.net
If you do not find the product you’re looking to order, please select OTHER as the category and type in the SKU details and Quantity as clearly as possible

We're sorry, but this form has spam protection that requires JavaScript to be enabled to work correctly. If you'd like to contact us via this form, please enable scripts in your browser and reload the page.How to enable scripts

All required fields are marked with a *

Provider Information

Customer Number*

Shipping Address

Contact Name*

Street Address*

City*

State/Province*

Zip*

Country*

Billing Address

If none is provided, will use default

Street Address

City

State/Province

Zip

Country

Order Information

PO Number*

Category*

SKU Details*

Add Another Product

Shipping Instructions

Payment Terms*

Payment Instructions

Upload File

Accepted formats: PDF, Images (JPG, PNG, GIF, BMP)

One file per form is permitted

Order Confirmation Contact

Email Address

Receive a copy of the order

This site is protected by hCaptcha and its Privacy Policy and Terms of Service apply.