Repair / Service Request Form

Repair / Service Request Form
To help us process your repair quickly please complete this form,
print a copy and include it in the box with your repair.
The more detail you provide to us will result in faster processing of your repair.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com

Items for Service/Repair: *

Item for Repair

Serial Number

Date of Last Service

1

2

3

4

5

Reason for Repair:

Non-Warranty Service/Repair *Warranty Service/Repair
*Must provide proof of warranty. Copy of your receipt purchased from an authorized retailer, warranty card, etc. Please include in your box.
Explanation: *

(required for repair) 0/500
Signature

Clear
Date
Scuba.com, 1781 Newport Blvd, Suite A & B, Costa Mesa CA 92627
Should be Empty: