PRINT ALL of THIS PAGE
SEND IT WITH THE BOTTLE

 


Name (print carefully) ________________________________________________________Date___________(Sign bottom of page)

Return Street Address____________________________________________________ (no PO boxes please)

City_________________________State_______zip_______
Is this a residence? _YES OR NO_ (circle one)

E-mail __________________________________________________ Phone_________________________

Bottle Type______________(Luxfer, SCI, Carlton) _____
E-Number #___________OR 3AL or 3HT (circle one)

Regulator Type_______________________(PMI, Crossfire, etc) located on top of bottle....

Do the best you can on this bottle/regulator information.

Special Instructions to Hydrolab

Instruct HydroLab to do the following, (check all that apply, each price is per bottle)

__ Hydrotest Cylinder _____X x $25.95 =
__ Remove Valve/regulator (must be removed for testing) _____X x $5.00 =
__ Re-attach Valve/regulator _____X x $5.00 =

__ Regulator Rebuild (can be done without hydro service, but hydro __ __ must be current for rebuilding) ---

_____X x $25.00 =
__ Shipping/Handling ground UPS per bottle (choose this or 2nd Day) _____X x $11.95 =
__ OR Shipping 2nd Day Air per bottle (includes $20 expedite fee) _____X x $53.95 =
  __New Ninja 4500 psi Regulator _____X x 59.00 =
    TOTAL =
*Washington state residents, please enclose 8.5 % tax.
Enclose Personal Check, Money Order, cash or with the following credit card information.

Credit Card#________________________exp__________

Name on card______________________________________
(VISA, MasterCard, Amex) circle one)

Signature of card holder_________________________
______(needs to match name on card.)
*Credit card payments must include: Number, expiration date and signature.
**You will be billed regardless of pass/fail of bottle.

***
"Walk ins" are welcome at $34.95 regardless of regulator removeal (call ahead of time)

Ship to:
HydroLab
5000 Burwell st
Bremerton, Wa. 98312
1. Remove all air from bottle
2. Make sure your name is on the bottle (use tape, write your full name)
3. Remove any covers or protectors and valve (or indicate that you want us to remove it).
4. You will need to put your valve back onto the tank, and make the appropriate adjustments after we return your tank. Check all attachments for seal and security upon return of bottle.
5. Bottles received on Friday, may be tested and shipped on Monday or Tuesday!

6. We recommend that you seek out the advice and services of a quality airsmith for removal and replacement of your Valve/regulator, or request HydroLab to re-attach the valve.
************ MAKE SURE YOU HAVE SIGNED THE BOTTOM OF THIS FORM********

  • We provide valve removal and replacement as a optional service. This service is not a requirement, for us to Hydrotest the bottle. However, all valves must be removed to be tested.
  • Please note that some regulators may be overly difficult to remove due to over application of torque or locktite during previous installation. Some have been know to break off during removal or replacement. HydroLab is not liable for previous damage during installation or previous removal attempts.
  • Bottles that are tested and NOT recertified (did not pass Hydrotesting), will be rendered inoperable (hole drilled in them),based on DOT regulations.
  • Full payment of the all fee's is required, regardless of certification status.
  • Questions.... no problem... use the HydroLab HotLine: 877-HYDROLAB between 10 am and 6 PM Pacific Time. Or email info@hydrotester.com

    Please test my cylinder_______________________________________________ _______________

    -----------------------------------------Signature
    ---------------------------------------------------------Date
    ------------------------******Check all attachments for seal and security upon return of bottle.********