AED Request Form

AED Ordering Delay

Please note, AED order requests are still being processed at this time; however please expect delays in shipping.

AED Request Contact Info

Name

Department/Unit

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Please note that only UC Davis affiliates are eligible to purchase a public access AED as part of UCDFD program.

Your Department Re-charge Account

Account information will only be used in the event of final purchase of an AED for your unit/department.

Tell Us About Your AED Needs

Do not fill out this field