Name
*
First Name
Last Name
Cell Phone
*
(###)
###
####
Email
*
Equipment Drop-off Date
*
MM
DD
YYYY
Date Requested
Please allow 3 weeks for gear service. Leave blank if you do not have an upcoming dive or trip.
MM
DD
YYYY
Date of Last Serviced
Leave blank if unknown
MM
DD
YYYY
Service Requested
Check all that apply
First Stage Brand, Model, Serial Number
Additional First Stage Attachments
Primary Second Stage Brand, Model, Serial Number
Alt Air / Second Stage Brand, Model, Serial Number
BCD Brand, Model, Size
Other Equipment Brand, Model, Serial
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.
Thank you! If you have not already dropped your equipment off at the store, please bring your equipment in and let the Scuba Charlotte crew member know you have completed the Equipment Servicing Form online.
