���

Amigos Gov�t/USCG 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 (5% discount)	$57
Wrist (each) (5% discount)	$28.50
3 for 1 Special on Full Suit (neck and both wrists on same suit)	$100.00
Hole Patching	$20/hr
Leak Test	$20
Hypalon Knee Patches	$20 per
Aquaseal (1oz. tube)	$5.95
303 Protectant (2 oz. bottle)	$3.75
	SUBTOTAL
Shipping & Handling
shipping per box	$15.00
additional suits per box	$2.00 each
	TOTAL
*NC RESIDENTS MUST ADD 7% SALES TAX
*TOTAL

Name:______________________________________________________________

Address:___________________________________________________________

City, State:_________________________________________________________

Phone Number:____________________________________________________

Email:_____________________________________________________________

                  PAY BY CREDIT CARD

Card Type	_________________________________________________
Name on Card	_________________________________________________
Number	_________________________________________________
Expiration Date	___________________________
Verification Code (found on reverse side of your credit card)	___ ___ ___ ___ ___ ___ ___

Cut here for Post Office Shipping

Amigos Drysuit Repair

104R NC Hwy 54 West, Suite 314
Carrboro, NC 27510