Request Service for returning customers

Lead Source Specific
Customer Account Information
Choose 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
Are you a distributor?*
- Yes
- No
Tax Exempt Number*
Please enter your tax exempt id, if applicable
Fire Department Name*
Name*
First Last
Department Name*
Company Name*
Title*
Phone*
Email*
The email where you'd like to receive all communications and updates.
Shipping Address*
Street Address*
Address Line 2
City*
State*
ZIP Code*
Shipping Address*
Street Address Address Line 2 City Province Postal Code
Billing Address Same as Above?*
- Yes
- No
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Service Requirements
Select 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 Request
List the Quantity of Each Item to be Sent into Gear Wash*
Add "0" to any item you are not sending in.
Boots Gloves Helmets Hoods Turnout Jackets Turnout Pants
Other? Please Specify
Description Quantity
Does Any of Your PPE Require Bio Decontamination or Heavy Decontamination?*
- Yes
- No
List Any Special Instructions Below:
Inspection Request
List the Quantity of Each Item to be Sent into Gear Wash*
Add "0" to any item you are not sending in.
Boots Gloves Helmets Hoods Turnout Jackets Turnout Pants
Other? Please Specify
Description Quantity
Is There Anything We Should Pay Special Attention to During Inspection?
Alteration Request
Which 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 Request
Gear 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.
Coat 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 Claim
Type 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 Quote
Which 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:
Consent
Any 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 Agreement
Service 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 representative
New 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.
Optional
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You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy.By clicking submit below, you consent to allow Gear Wash to store and process the personal information submitted above to provide you the content requested.

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Request Service for returning customers

Customer Account Information

Service Requirements

Cleaning Services Request

Inspection Request

Alteration Request

Letter Patch Request

Repair or Warranty Claim

Package Quote

Consent

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Additional Resources

Description	Quantity

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