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CONTACT INFORMATION:
Name: __________________________________________ Home ___________________________________________
Billing Address:
________________________________________________ Cell
________________________________________________ Fax
Shipping Address:
________________________________________________ EMAIL: _________________________________________
________________________________________________
EQUIPMENT:
Please list all equipment shipped to us and describe symptoms or work requested. Please specify if you believe any
of our services should be considered a warranty repair.
1) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
2) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
3) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
4) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
SCHEDULING:
You will receive a free estimate by phone or email within ten days of receipt. Most repairs are completed within
three weeks from your estimate approval. Please note that delays could happen due to lack of parts or during peak times. Please note
your next trip date below for completion. IF YOU REQUIRE RUSH SERVICE YOU MUST CALL FOR SCHEDULE APPROVAL.
My next trip date:
PAYMENT AND ESTIMATE APPROVAL:
approving service fees. If our technicians determine the fee will exceed your pre-authorized amount, we will send an estimate for your
approval. ALL RUSH REPAIRS MUST BE PRE-AUTHORIZED. SHIPPING FEES ARE NOT INCLUDED IN REPAIR ESTIMATES.
ESTIMATES.
___
Please begin work immediately if fees are less than $ ________________________________
Bill my credit card: (circle one) MC / VISA / AMEX / DISC ______________________________
___
Please email, fax or call for my approval
COMMENTS:
22740 Portola Drive, Salinas, CA 93908
Check if RUSH only:
___ I have called and confirmed a RUSH schedule
___ I approve the quoted RUSH fee maximum charge
If your trip date is within four weeks, we recommend you expedite the repair by pre-
Expiration Date ________________________________
831-484-6233
SERVICE - WEST REQUEST FORM
Phone:
Work ___________________________________________
___________________________________________
___________________________________________
service@subaquaticcamera.com
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