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Company Name(print)_____________________________________Authorization
Signature ______________________________________Date___________________
Return Street Address_________________________________________________________
City___________________State_______zip_______ (no
PO boxes please) Is this a residence? _YES
OR NO_ (circle one)xxxxxxxx
UPS Number___________________
E-mail _________________________ Phone_________________________Federal
Tax Id#______________________(0) check if on file
Please Identify each bottle type (E#, 3al or 3HT)
Bottle 1____________________Bottle
2____________________Bottle
3____________________Bottle
4__________________Bottle
5___________________
Bottle
6____________________Bottle
7________________________Bottle
8____________________Bottle
9__________________Bottle
10__________________
..
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Special
Instructions to Hydrolab
|
Instruct
HydroLab to do the following, (check all that apply, each
price is per bottle)
|
__ Hydrotest Cylinder |
_____X |
x
$14.00 |
= |
| __
Remove Valve (must be removed for testing) |
_____X |
x
$2.50 |
= |
| __
Re-attach Valve |
_____X |
x
$2.50 |
= |
__
Regulator Rebuild (can be done without hydro
service)
PMI Old and New Basic service (top not replaced)
|
_____X |
x $12.50 |
= |
|
|
|
= |
| __
Pre Paid Shipping ($7 per bottle) |
_____X |
|
= |
| |
|
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 company 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.
Most will be shipped on the day recieved. |
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.
Check
all attachments for seal and security upon return of bottle.
|
-
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.
-
Bottles that are tested and NOT recertified (did not pass
Hydrotesting), will be rendered inoperable (hole drilled
in them).
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Full payment of the Hydrotest fee is required, regardless
of certification status.
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Questions.... no problem... use the HydroLab
HotLine: 877-HYDROLAB
between 10 am and 6 PM Pacific Time. Or
email info@hydrotester.com
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