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To help us process your repair quickly please print this form, complete and
incl
ude it in the box with your repair.

First Name:________________________________________________________
Last Name:________________________________________________________
Address:__________________________________________________________
City:______________________________________________________________
State: ____________________________________________________________
Zip: _____________________________________________________________
Phone: ___________________________________________________________
Email:____________________________________________________________

Payment Option:

         Credit card  Name on Card__________________________________
         Call for payment  Credit Card #__________________________________
  Expiration Date: (MM/YY)__________________________


Item for Repair                         Serial Number                              Date of Last Service

     
     
     

.

 

 

 

 

 

Reason for repair:

        Non-Warranty Service/Repair                   Warranty Service/Repair*                     Other

*Must provide proof of warranty. Copy of your receipt of purchase from an authorized retailer, warranty card, etc...            
Explanation: (required for repair)

                                                                                                                                                                                                       

                                                                                                                                                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                       

                                                                                                                                                                                                       

                                                                                                                                                                                                       

                                                                                                                                                                                                                                                                                                                                                                                                               

Our Repair Policy

Unless the customer provides proof
of warranty (Copy of your receipt of purchase
from an authorized retailer, warranty card, etc.)
the cost of parts will be added to the estimate.
Note: Tanks may need internal cleaning
and/or liner removal which may increase
the cost of servicing substantially.
Scuba.com is not responsible for equipment
not paid for within 90 days
and all such equipment will be sold to
recover repair costs.

Signature:___________________Date:_________

Scuba.com Service Department              Questions?

1752 Langley Avenue                                                   949-459-9400

Irvine, CA 92614                                                          Repair@scuba.com