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Service Ticket

Submitted on May 12, 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*
Second Client 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*
Third Client 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*
Fourth Client 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*
Fifth Client 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*
Sixth Client 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*
Seventh Client 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*
Eighth Client 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*
Ninth Client 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*
Tenth Client 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*
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*
I certify that I am 18 years of age or older


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