Please Note:
Home Oxygen Concentrator ($80/day, $325 for 5 days, $350/week, delivery & pickup are free) 3 free nosepieces are included with each machine, $3 each additional Humidifier bottle, splitter, extension tubing and instructions are included with each machine (Philips Respironics Everflo Q Concentrator)
**Oxygen will be delivered on your preferred start date/time. You will not be charged on the return date.
Guest Information
*Condominium, Hotel, or Address:
*I authorize Telluride Delivers to receive payment for services rendered using the following option: Credit Card I would like to tip the delivery person $5 $10 $15 $20 $25 $30 $35 $40 $45 $50 $55 $60 $65 $70 $75 $80 $85 $90 $95 $100 Other $: *Initials (Required for Web Submission): Signature (For Fax Orders Only): "By Signing/Initialing above I am authorizing charges to my credit card, and I am affirming that the recipient(s) of any alcoholic beverages are 21 years of age or older. I understand that Telluride Delivers will not be held responsible for any mishandling of alcohol by minors".
*Driver's License # (If Purchasing Alcohol): *D.O.B.:
We recommend you print this page for your records before submitting!
If you do not receive a confirmation within 24 hours, please call 970-729-3223 Please review your order carefully before submitting. All fields with a "*" are required If you are travelling to Telluride in less than 48 hours, please drop us a line and let us know @ 970-729-3223 If you are emailing your own list, only the Guest Information section of this form and Credit Card Information are necessary
Thank you - we appreciate your business!