Monmouthmarine

SERVICE REQUEST

Deposit Required

Monmouth Marine Engines, Inc. will not perform any service(s) without a deposit.

Credit cards are not kept on file. Credit card information must be provided prior to start of service(s).

Credit card information must be provided prior to start of service(s). *

AMEX

Discover

MasterCard

Visa

Credit Card Number *

Exp. Date *

Three / four digit security number *

Please select one: *

A deposit of $300.00 dollars is required for all services. Please charge deposit and final balance to my credit card. If you cancel your appointment less than 24 hours prior to your scheduled service, your service deposit is non-refundable.

I authorize the services up to a limit of (check one): *

$450.00

$600.00

$900.00

$1,200.00

$2,400.00

Estimate Only

I hereby waive my right to receive a written estimate to complete the requested services.

TERMS AND CONDITIONS OF MONMOUTH MARINE ENGINES SERVICE REQUEST

Term and Conditions

I hereby authorize the requested services to be performed with the necessary material(s) and hereby grant Monmouth Marine Engines, Inc. permission to operate the boat herein described on local waterways for the purpose of testing and/or inspection.
Monmouth Marine Engines, Inc. is not responsible for unavailability of parts or delays in parts shipments beyond our control or for the loss or damage to boat or articles in boat in case of fire, theft or any other cause beyond our control.
Monmouth Marine Engines, Inc. reserves the right to not install any customer supplied parts.
ESTIMATE: A dignostic charge may be charged to establish an estimate of total cost for the purpose of obligating funds and establishing a ceiling that may not be exceeded without the prior approval of the customer.
Due to insurance regulations: no work below the water line is permitted by the owner or representative; including bottom paint, thru hulls, zincs, etc.
An environmental fee of three percent of the accrued parts total will be applied to each service order. A shop material fee of five percent of the accrued labor total will be applied to each service order.
NON-PAYMENT: In the event of non-payment for repairs and/or materials, pursuant to this service order, I agree that an expressed mechanics lien is hereby acknowledged on herein boat to secure payment. In accordance with the provisions of the State of New Jersey statute, I hereby represent to Monmouth Marine Engines, Inc. that I am the owner of the boat and have authorization to order and/or request repairs. In the event that the balance is thirty days past due, the account will be subject to a three percent monthly service charge and assigned for collections.
JURISDICTION: In the event that there are disputes concerning any services performed on the Boat, I agree that the jurisdiction shall be vested in the superior court of New Jersey, Law Division at the Monmouth County Court House, Freehold, NJ and hereby consent to in personum jurisdition, by means of forwarding a Summons and Complaint by certified mail, return reciept requested.
TRAVEL: I agree to pay the mobile / off-site mechanical work labor rate for the technicians travel time to and from the work site.
WARRANTY: Provide proof of manufacturers / extended warranty. Must be submitted with service request.

LABOR RATES:

On Site Mechanical Work	$125.00/hr
Mobile / Off Site Mechanical Work	$150.00/hr
After Hours / Emergency Services	$215.00/hr: 1 hr. min.

OWNER INFORMATION

Name *

Address *

City *

State *

Zipcode *

Home phone

Work phone

Cell phone *

Fax

E-mail *

SERVICES REQUESTED

Please complete area below to provide information regarding systems and services requested.

Port Engine Model

Port Engine Serial Number

Port Drive Model

Port Drive Serial Number

Stbd Engine Model

Stbd Engine Serial Number

Stbd Drive Model

Stbd Drive Serial Number

Generator Model

Generator Serial Number

Service(s) Requested *

OTHER INFORMATION

Declaration page of insurance policy required on file. Please upload insurance document *

Please upload your insurance document

All parts removed will be discarded unless otherwise specified

Save parts

Vessel Name

Location (Service) *

Location (Keys) *

Signed work order required for all service repairs requested. NO EXCEPTIONS.

Authorizing Signature (Please enter your name) *

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

Date *

Agree to Terms and Conditions *

I read and agree to Terms and Conditions stated above

Service Authorization Form