Amigos Work Order Form
Please follow these easy steps in order to have us replace your gaskets:
- print this page
- fill in the form below
- clip appropriate address off the bottom of the form to use as a mailing label
- box your garment up and mail it to us.
|
Item |
Cost |
Quantity |
Total |
|
Neck |
$60 |
|
|
|
Wrist (each) |
$30 |
|
|
|
Ankle (each) |
$32 |
|
|
|
Pair of Latex Socks |
$78 |
|
|
|
Full Suit with Ankles (10% discount) |
$165.60 |
|
|
|
Full Suit with Socks (10% discount) |
$178.20 |
|
|
|
Patching |
$20/hr |
|
|
|
Aquaseal (1oz. tube) |
$5.95 |
|
|
|
303 Protectant (2 oz. bottle) |
$3.75 |
|
|
|
|
SUBTOTAL |
|
|
|
Shipping & Handling (CHOOSE RATE BASED UPON SUBTOTAL) |
|||
|
$0.01-$9.99 |
$2.00 |
|
|
|
$10-$60.99 |
$8.00 |
|
|
|
$61-$199.99 |
$10.00 |
|
|
|
$200-Up |
$16.00 |
|
|
|
|
TOTAL |
|
|
|
*NC RESIDENTS MUST ADD 6.75% SALES TAX |
|
||
|
*TOTAL |
|
||
Name:______________________________________________________________
Address:___________________________________________________________
City, State:_________________________________________________________
Phone Number:____________________________________________________
Email:_____________________________________________________________
PAY BY CREDIT CARD
|
Card Type |
_________________________________________________ |
|
Name on Card |
_________________________________________________ |
|
Number |
_________________________________________________ |
|
Expiration Date |
___________________________ |
|
Verification
Code |
___ ___ ___ ___ ___ ___ ___ |
|
|
|
| Cut here for Post Office Shipping
|
|
| Amigos Drysuit Repair 1037 Russell's Ford Road
Chapel Hill, NC 27516 |
|