YOU CAN FILL OUT THIS FORM ON THE COMPUTER – PRINT IT OFF – AND BRING IT IN WITH YOUR EQUIPMENT FOR SERVICE/REPAIR.
	KANATA DIVING SUPPLY SERVICE DEPARTMENT EQUIPMENT SERVICE / REPAIR REQUEST FORM In order to best serve you, please complete the following form, providing as much detail as possible. Incomplete or missing information could delay the completion of your repairs.
Name:
Cert.Level:
Address:
Daytime Tel.:
Evening Tel.:
Email:
Date Required:
	Every effort will be made to complete the service/repairs by the date requested, however, we cannot guarantee completion dates/times due to circumstances beyond our control [including but not limited to workload, allotted repair time and parts availability].
Equipment [Brief Description]
	Annual Service Estimate Only Repair as Necessary Other [Specify Below]
Details:
	I (signed below) authorize Kanata Diving Supply and it’s staff to complete all repairs as listed above. I understand that Kanata Diving Supply bears no responsibility for the loss or damage of this equipment if it is left at Kanata Diving Supply more than 30 days after I am notified service is complete. Kanata Diving Supply retains the right to refuse any repair that it’s staff considers unsafe or unfit as detemined by the age or condition of the equipment.
Signature:
To Be Completed By Kanata Diving Supply:
Date Received:
Completed: