2023 MOBILE SERVICE Request Form

IMPORTANT: Please read & complete all sections of this form carefully, this is your work order.

First Name *

Last Name *

Phone Number *

Email Address *

Marina Name, Dock and Slip Number OR Boat House Address - *

Boat Key Location: PLEASE BE SPECIFIC - KEY MUST BE ON BOARD BEFORE THE DATE OF REQUEST. If your boat is in a boathouse, be sure we have the codes/keys needed to access the boathouse or leave it unlocked. If we cannot perform our job due to lack of access or missing key, additional service call charges will be incurred *

Boat Color/Manufacturer *

Engine Year, Make, Model/Serial Number

TARGET DATE

Target Date: NOTE - this is a target date to assist LLM in scheduling. The chosen date does NOT guarantee your boat will be scheduled this day. We run mobile calls a couple of days a week... * +

AVAILABLE SERVICES: All Prices are approximate, plus tax, and subject to change. A Pricing breakdown will be provided on the next page before confirming your request.

Diagnose Failure or Problem - all boat systems
Please note: We don't perform maintenance services on the lake. Please complete a haul out request

Service Call $55 (required)

Diagnostics $155/hr (billed per hour, minimum one hour)

Please Summarize Symptoms for Diagnostics/Repair

Please enter your credit card details in the secured boxes below. YOUR CARD WILL NOT BE CHARGED AT THIS TIME. Invoices will be sent via email. Invoices not paid within 30 days will be charged to the card on file. All Credit Card charges will have a 3.5% processing fee added. Invoices must be paid before the boat is returned unless prior arrangements have been made.

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

CVC code

Billing Zip Code

Please sign your work order request. Once submitted we will receive an email with your request & add it to the schedule. TERMS: I hereby authorize the above work to be completed along with needed parts/materials. Lake Lure Marine (LLM) & Employees may operate boat/engine for purposes of testing, inspection, and/or pickup or delivery at my risk. LLM will not be held liable or responsible for loss or damage to boat/engine due to fire, theft, accident or any other cause beyond our control. Invoices must be paid in full. Late fees will be incurred for all overdue invoices, charged to the card on file and include a 3.5% processing fee based on the invoice total. Owners must keep insurance on all boats/trailers in storage. *

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Please check the box below to submit request, approximate pricing to be provided on the next page before finalizing your request. *

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