New Service Request

Unit Type(Required)

Horizon

rEvo

Model:(Required)

Serial Number:(Required)

What electronics do it have?(Required)

Serial Number:(Required)

Name:(Required)

Phone

Email(Required)

Address

Service Requested(Required)

5 Year Service

10 Year Service

Counter Lung Replacement

Other

Specify:(Required)

Known Issues(Required)

Need by Date(Required)

Are you shipping to Michigan?(Required)

Ship your unit to:
Rivalry Logistics C/O Benthic Scuba
2396 E 10 mile Rd
Warren, Michigan, 48091

I, , am the owner of a rEvo rebreather, serial number . I am sending my unit to Ron Waxman at Benthic Scuba in Tecumseh, Ontario to have service work done on it. The unit will be shipped back to me at my expense once completed.

Upload Driver license or passport for border purpose.

Max. file size: 1 GB.

Signed and dated:(Required)