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Service Ticket

Submitted on July 1, 2025.


By signing, you (and the parties you represent) are stating that you have read and are agreeing to the terms of service and release of liability outlined by Columbia Scuba

First Client Name
First Name*
Last Name*
Phone*
First Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
First Client Signature*
Second Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Second Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Second Client Signature*
Third Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Third Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Third Client Signature*
Fourth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Fourth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Fourth Client Signature*
Fifth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Fifth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Fifth Client Signature*
Sixth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Sixth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Sixth Client Signature*
Seventh Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Seventh Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Seventh Client Signature*
Eighth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Eighth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Eighth Client Signature*
Ninth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Ninth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Ninth Client Signature*
Tenth Client Name
First Name*
Last Name*
Client Date of Birth*
Date of Birth
Tenth Client Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Tenth Client Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Client Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information

Make, Model, and Serial Number of Service Items: *
Service Turn-Around Time:*
Please Select Service Option:*
Computer Battery Change*
May We Change Out* (Check all that apply)
Bad Mouthpieces
Dry Rotted or Leaking Hoses
High Pressure Spool O-Ring
Please Call if Total Cost Will Exceed:

Additional Comments:
Parent or Guardian's Signature*
First Client Age Acknowledgment*
First Client Date of Birth*
Date of Birth
I certify that I am 18 years of age or older


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