|
Name (print)____________________________________Date_________________(Sign
bottom of page)
Return Street Address_________________________________________________________
City___________________State_______zip_______ (no
PO boxes please) Is this a residence? _YES
OR NO_ (circle one)
E-mail _________________________ Phone_________________________
Bottle Type______________(Luxfer, SCI, Carlton)
_____E-Number
#___________OR 3ALor 3HT (circle
one)
Regulator Type_______________________(PMI,
Crossfire, etc) located on top of bottle....
| Special
Instructions to Hydrolab
|
Instruct
HydroLab to do the following, (check all that apply, each
price is per bottle)
|
__ Hydrotest Cylinder |
_____X |
x
$17.95 |
= |
| __
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) ---PMI/Pure
Energy Only. |
_____X |
x $25.00 |
= |
| __
Shipping ground UPS per bottle (choose
this or 2nd Day) |
_____X |
x
$7.95 |
= |
| __
OR Shipping 2nd Day Air per bottle |
_____X |
x
$20.00 |
= |
| |
|
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.
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 shipped on Monday! |
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.********
|
