Name
*
First Name
Last Name
Cell Phone
*
(###)
###
####
Email
*
Gear Drop-off Date
*
MM
DD
YYYY
Next Dive Trip Date
Please allow 3 weeks for gear service. Leave blank if you do not have an upcoming dive or trip.
MM
DD
YYYY
Service Requested
Date of Last Service
MM
DD
YYYY
What was done during gear last service date?
Are there any known problems that we should know about or address?
First Stage Brand, Model, Serial Number
Additional First Stage Attachments
Second Stage Brand, Model, Serial Number (Primary)
Second Stage Brand, Model, Serial Number (Octo/Alternate Air)
Second Stage Brand, Model, Serial Number (Octo/Alternate Air)
Does computer & Transmitter need a battery replacement?
No
Yes
Not Sure
BCD Brand, Model, Size
Gauges
Other Equipment Brand, Model, Serial
Mouthpieces: If the technician finds that they do need replacing, it is it ok to replace?
No
Yes
Low/High Pressure Hoses: If the technician finds that they do need replacing, it is it ok to replace?
No
Yes - Miflex Hose
Yes - Rubber Hose
Additional Accessories:
We recommend taking equipment out of bags and taking off all accessories. Please indicate if you are leaving any accessories on your gear
Your cooperation in completing this form is greatly appreciated. Unless we encounter an unanticipated problem, we will complete the work requested and have your equipment ready for pick-up in three weeks. Please understand that it will also be your responsibility to test this equipment when you receive it back to confirm the service was performed to your satisfaction.
*
NOTE: any equipment left over 30 days after completion of the service is subject to a $25/month storing fee.
