Rex Marine Service Form

Service Department Work Order Request

144 Water Street- Norwalk, CT 06854

Service Phone: 203.866.5555 Service Email: Service@rexmarine.com Website: www.rexmarine.com

Rex Marine services exclusively Powerboats. Please contact Norwalk Cove Marina if a sailboat.

Note: This request form does not create an appointment nor confirm acceptance of your work request. Please contact service@rexmarine.com if no reply has been received within 1 business day.

Requests for Warranty work must be explicitly indicated on this form, and can only be made for manufacturers for which Rex marine is an Authorized Dealer. Vessel and engine serial number(s) must be included if a warranty request. We will then email our Warranty Policies to you for your review and return with your signature.

Boat Owner's First Name: *

Boat Owner's Last Name: *

Address: *

City: *

State: *

Zip Code: *

Contact Phone: *

Email: *

VESSEL INFORMATION

Make: *

Model: *

Year Built: *

Beam: *

Length Over All (LOA) *

Boat Registration Number: *

Hull Number: *

Key Location or Combo: *

ENGINE INFORMATION

Make of Motor(s): *

+-

Model: *

Year: *

HP: *

Type of Motor: *

Inboard

Sterndrive

Outboard

Single Serial # : *Mandatory For an Engine Warranty Request*

Twin Serial # :

Triple Serial # :

Quad Serial # :

Please provide a detailed description of the problem, or service(s) requested. Please indicate item(s) subject to warranty consideration. *

I hereby authorize the work to be done along with the necessary materials. I accept the terms and conditions. I grant Rex Marine Center permission to operate the boat and/or equipment hereon described for the purpose of testing and inspection. Rex Marine Center is not responsible for loss or damage to boats or articles left in boats in case of incidents beyond control. An express mechanics lien is hereby acknowledged on above boats and/or equipment to secure the amount of repairs thereto.

1. Full Payment is due upon invoicing.

2. If your boat is not contracted for dockage or other Storage at Rex Marine, full payment is required prior to vessel pickup/removal.

3. Unpaid invoices are subject to a 1.5% monthly finance fee after over 30 days.

4. Unpaid invoices 60 days or older will be referred to a debt recovery agency.

5. If your boat is not contracted for dockage or other Storage at Rex Marine, we offer up to three days of courtesy storage prior to your pickup. Daily storage fees apply after three days. Delivery is available, pricing upon request.

Note: This request form does not create an appointment nor confirm acceptance of your work request. Please contact us if no reply has been received within 1 business day.

Requests for Warranty work must be explicitly indicated on this form, can only be made for manufacturers for which Rex marine is an Authorized Dealer. Vessel and engine serial number(s) must be included if a warranty request. We will then email our Warranty Policies to you for your review and return with your signature.

PAYMENT METHOD

Credit Card Type *

Name on Card *

Credit Card Number *

CVV: *

Expiration Date (mm/yy) *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Today's Date *

This signed authorization allows Rex Marine Center to charge my credit card for the work requested if boat is removed prior to full payment.

Method of Payment: *

I plan to use this credit card as a method of payment to cover repairs.

My card info is included, but I plan to pay by check.