Underwater Sports, Inc.
Technical Services Department
10545 Aurora Ave. N.
Seattle, WA 98133
(206) 362-0732
service@underwatersports.com

Please fill out this form completely - one for each BCD.

Company, Department, or Team Name if applicable.

Last Name

First Name

Address 1

Address 2

City

State

Zip

Contact Phone#

Email Address

BCD Information

BCD Components (Put N/A in non-applicable fields)

	Manufacturer	Model	SN#, Size, Color
BCD
Inflator
Alt. Inflator
Other

Purchased from (Store , City & State required if requesting warranty work)

Date of Purchase (Roughly)

Purchase Price (Roughly)

Service Requested

Please check all that apply:

Please describe symptoms, issues and other service/s requested:

Verify, Print and Submit

I understand that life support equipment will be returned to me in manufacturers specifications. I understand that by submitting this form I am authorizing Underwater Sports, Inc. to perform all the work requested. I further understand that any items which are unpaid as of 90 days of the completion of the repair, without prior arrangements, become the property of Underwater Sports, Inc. and that such items will be disposed of to recoup the cost of parts and labor.

Electronic Verification
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A copy of this form will be sent to your email as verification.
Please print a copy and include it in the box with BCD.

Indicates Response Required

Annual Service BCD	Overhaul BCD	Overhaul Inflator
Overhaul Alt. Inflator	Clean BCD	Check for Leaks
Replace Inflator	Sew/Fix (Specify below)