Print this form and attach it to your gear

 

Name:______________________________________________________

Complete Address:____________________________________________

City:_________________________________ ST:_____ Zip:____________

Phone Numbers: Day: __________________  Evening: __________________

E-mail address:_________________________________________________

Please Check What You Would Like Serviced
___ B.C.D.
___ Regulator 1st Stage And Primary 2nd Stage
___ Alternate Air Source (Octopus)
___ Computer Or Depth Gauge Check 0-130 FT
___ Mouthpiece Replacement.
___ Battery Change (Some Models May Need To Be Shipped To The Manufacturer)

Travel Departure Date:_____________ (If Applicable)

Please Either Leave Credit Card Information Below Or Call Us At 303-789-2450 Or
1-800-783-7282.

Credit Card:_______________________________________

We Can Usually Turn Your Equipment Around In Less Than One Week

You Will Receive A Confirmation Call or E-mail When We Receive Your Equipment, And One
More The Day We Ship It Back To You.

Comments Or Requests:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

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By signing this Service Agreement, I hereby authorize A-1 Scuba and Travel Center, Inc. to perform the services that I have chosen. I recognize that the prices quoted are for services only, and do not include parts, such as hoses, mouth pieces and batteries.

A-1 Scuba and Travel Center, Inc. reserves the right to not service equipment that cannot reasonably be placed in a safe operating condition. All equipment, unless specified otherwise, is only to be utilized with a mixture of approximately 21 percent compressed air. Nitrox cleaning is available, if requested.

A-1 Scuba and Travel Center, Inc. recommends that all equipment be thoroughly inspected and tested for safety and proper operation prior to each dive.

I understand and agree that A-1 Scuba and Travel Center, Inc. makes no guaranty, representation or warranty including any implied warranty of merchantability or fitness for particular purpose with respect to the diving equipment serviced.

I hereby state I carefully reviewed this Service Agreement, and I acknowledge, recognize, appreciate, and assume all risks inherent in the sport of scuba diving and in the use of scuba diving equipment and waive each and every claim for injuries, damages and losses, including claims for negligence, which I may have against A-1 Scuba and Travel Center, Inc. and its employees, instructors, agents, and representatives, arising out of services performed or not performed under this Service Agreement.

I understand that if A-1 Scuba and Travel Center Inc. should be found liable for any injuries, damages and losses due from a failure to perform any or all of its obligations or a failure of the equipment to properly operate, A-1 Scuba and Travel Center, Inc.’s liability shall be limited to a sum equal to the total of the monies that were paid A-1 Scuba and Travel Center, Inc. for servicing and this liability shall be exclusive and apply if loss or damage, irrespective of cause or origin, results directly or indirectly to persons or property from performance or non-performance of any of A-1 Scuba and Travel Center, Inc.’s obligations or from negligence, active or otherwise, of A-1 Scuba and Travel Center, Inc., and its employees, instructors, agents, and representatives. This Agreement shall be binding upon myself, heirs, and legal representatives.

 

Thank You For Your Business!

Ken Snyder, Service And Repair Manager
1603 W. Belleview Ave., Littleton, Co. 80120
(303) 789-2450 · (800) 783-7282
FAX (303) 781-6723
ksnyder@a1scuba.com