EQUIPMENT INTAKE FORM
Ship your equipment to: Dive Lab Inc. 1415 Moylan Road, Panama City Beach, FL 32407 / Attention: Mike Ward Jr.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Company Name (If Company is Paying)
Name of a Person Sending Equipment
*
Phone
*
Email
*
example@example.com
Incomplete Billing and/or Shipping address will result in delay of service
BILLING ADDRESS
*
INCOMPLETE BILLING ADDRESS, WILL RESULT IN DELAY OF SERVICE
SHIPPING ADDRESS
*
IF SAME AS BILLING - TYPE SAME
SERIAL NUMBER
EXAMPLE: 9856KM
MODEL & COLOR
EXAMPLE: KM 37 W/455 REG BLUE
DESCRIBE WHAT SERVICE YOUR EQUIPMENT REQUIRES
*
USE THIS FIELD FOR SINGLE OR MULTIPLE EQUIPMENT, INCLUDE ANY IMPORTANT INFORMATION OR SPECIAL INSTURCTIONS
FOR MULTIPLE EQUIPMENT USE THE FIELDS BELOW
After you click SUBMIT - you will receive an email confirmation form. You may print the form and include it in the box, however it is not required
SUBMIT
Should be Empty: