Customer Account InformationChoose which Gear Wash location to service your gear:*(Choose the location closest to you for quicker ship times) Atlanta, Georgia Charlotte, North Carolina Dayton, Ohio Denver, Colorado Hudson, Florida Las Vegas, Nevada Miami, Florida Milwaukee, Wisconsin New York City, New York Are You a Current Gear Wash Customer?* Yes, I have done business with Gear Wash in the past No Tax Exempt # (if applicable)Leave blank if you do not have a tax exempt #. Name* First Last Department Name* Title* Phone*Email*The email where you'd like to receive all communications and updates. Shipping Address*United StatesCanadaStreet Address* Address Line 2 City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Code* Shipping Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Billing Address Same as Above?* Yes No Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Service RequirementsSelect the Services You'd Like to Request*Select all that apply. Routine Service (For Gear That Is Sent In Clean) Full Service (Clean & Repair as Needed) Cleaning Inspection Alteration Letter Patch Repair or Warranty Claim Service Package Quote Is the gear clean? Yes No Cleaning Services RequestList the Quantity of Each Item to be Sent into Gear Wash*Add "0" to any item you are not sending in.BootsGlovesHelmetsHoodsTurnout JacketsTurnout PantsOther? Please SpecifyDescriptionQuantity Does Any of Your PPE Require Bio Decontamination or Heavy Decontamination?* Yes No List Any Special Instructions Below:Inspection RequestList the Quantity of Each Item to be Sent into Gear Wash*Add "0" to any item you are not sending in.BootsGlovesHelmetsHoodsTurnout JacketsTurnout PantsOther? Please SpecifyDescriptionQuantity Is There Anything We Should Pay Special Attention to During Inspection?Alteration RequestWhich Items Will You Be Sending In?*Select all that apply Turnout Coat Turnout Pant Alternative PPE (Wildland, EMS, USAR, etc.) Describe in Detail the Alterations Needed:*Please include current size and desired size (example: add 4 inches to the waist)Letter Patch RequestGear Wash is well versed in adding letter patches to turnouts made by all manufacturers. Click here to review the types of letter patches we offer. This guide will help you answer some of the questions below.Enter Patch/ Lettering Style Code*Using the guide linked above, select the style you prefer and enter the item code below.Style AStyle BStyle CStyle DStyle EStyle FStyle GStyle HStyle IStyle JCoat Manufacturer:* Model or Model #:* Outer Shell Material and Color* Select Letter/Number Color* Lime/Yellow Red/Orange Select Letter/Number Size* 2 Inch 3 Inch Select Application Style* Loose Patch Patch Sewn to Shell Letters Sewn to Shell Heat Applied Letters Velcro Attachment Snaps Attachments Select the Desired Location of Patch:* Upper Back, Yoke Back, Above Chest Trim Mid Back, Below Chest Trim Hem, Above Trim Tail/Hanging What Lettering Do You Want to Appear on Your Upper Back, Yoke?*Write out the name exactly as you would like it to appear. Please double check before submitting. What Lettering Do You Want to Appear on Your Back, Above Chest Trim?*Write out the name exactly as you would like it to appear. Please double check before submitting. What Lettering Do You Want to Appear on Your Mid Back, Below Chest Trim?*Write out the name exactly as you would like it to appear. Please double check before submitting. What Lettering Do You Want to Appear on Your Hem, Above Trim?*Write out the name exactly as you would like it to appear. Please double check before submitting. What Lettering Do You Want to Appear on Your Hanging Patch?*Write out the name exactly as you would like it to appear. Please double check before submitting. Additional Instructions:*Repair or Warranty ClaimType of Repair* Repair as needed Repair as specified (see Special Instructions) Enter Special Instructions Here:Check here if you would you like a quote for repairs?Please note: requesting a quote will slow down the process of your gear repair. Yes, please contact me for a repair quote. Would you like to receive your quote at the email listed above? Yes No, I have another email I would like to use. Email* Which Items Require Repair*Select all that apply Jacket Outer Shell Jacket Liner Pant Outer Shell Pant Liner Turnout Manufacturer* Turnout Model* Cause of Damage*Select all that apply Chemicals Heat/Flame In-Service Use Improper Sizing Recruit Class/Fire Academy Tools UV Exposure Is This Request for a Product Under Warranty?* Yes No Manufacturer Approval #:*Please enter a number greater than or equal to 1.Date of Manufacturer* MM slash DD slash YYYY Serial #:*Please enter a number greater than or equal to 1.Package QuoteWhich Package Are You Interest in Having Quoted?*Select all that apply. Package details are outlines on our Service Packages page. Fee-For-Service Package Basic Package Advanced Package Managed Package What is the Size of Your Department?*Please enter a number greater than or equal to 1.Additional Information*If Your Department has a Budget in Place, Please Enter it Here:ConsentAny equipment sent to our facility MUST be clean before being handled by our associates. We reserve the right to perform a soil transfer test on any equipment submitted to determine if the item meets OSHA and Gear Wash safety standards based on our experience and sole judgment. Manufacturer warranty does not cover cleanings, inspections and shipping fees thus those services will be billed to the customer organization. Also, any repair labor or materials not covered under warranty will be billed to the customer organization. By signing this form, you agree to these terms.Rental Consent* I have read and agree to all terms within the Gear Wash Rental AgreementService Consent* I certify that I have read and agree to Gear Wash's Clean & Repair Policy.Routine Service* I certify that any gear sent to Gear Wash will be properly washed prior to shipment.As per the Clean & Repair Policy, Gear Wash reserves the right to perform a Soil Transfer Test (STT) on any item(s) cleaned by the customer to ensure it meets Gear Wash's safety standards for employee handling. Items that fail the STT, may be subject to on-site cleaning at the expense of the customer.Gear Wash Follow Up* Check here if you would like a follow up call from a Gear Wash representativeNew Customer Agreement*By signing and submitting this application, you agree to all payment terms per Gear Wash credit policies. This includes committing to pay all invoices within 30 days from the date of the invoice. Any dependencies noticed must be reported in writing within ten business days. You also verify that all information completed above has been thoroughly reviewed and is accurate to the best of your knowledge. You agree to comply with any terms set forth by Gear Wash relating to your service request.Signature*By signing and submitting this form, you verify that all information completed above has been thoroughly reviewed and is accurate to the best of your knowledge. You also agree to comply with any terms set forth by Gear Wash relating to your service request. Δ
