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work request
Work Approval Form
YOUR DETAILS
First Name
(*)
Last Name
(*)
Email
(*)
Contact Number
(*)
VESSEL DETAILS
Make
(*)
Model
(*)
Engine Type
(*)
Engine Model
(*)
Engine Serial Number
(*)
Vessel Name
(*)
Registration Number
(*)
Vessel Location
(*)
Mooring / Berth Number
(*)
Location of Vessel keys
(*)
DETAILS OF WORK REQUIRED
Details
(*)
PAYMENT DETAILS
Card Type
(*)
Mastercard
Visa
Cardholders Name
(*)
Card Number
(*)
Expiry Date MM/YYYY
(*)
CCV (Last 3 Digits)
(*)
BILLING ADDRESS
Unit / Street Number
(*)
Street Name
(*)
Suburb
(*)
Postcode
(*)
State
(*)
AUTHORISATION
Authorise
(*)
I authorise the work requested above and agree to pay for labour, spare parts and materials required for that purpose at the Superior Marine Services (SMS) current rates and prices. I authorise SMS to debit my Credit card on completion of work using completed credit card authorisation, SMS shall not be responsible for the loss or damage to the vessel, it's accessories or contents whilst berthed or being driven in connection with the work being authorised unless caused by the negligence of SMS or its employees. I agree to pay SMS reasonable storage charges if delivery of the vessel is not taken within two days after notice is given by SMS that the work has been completed.
Credit card details are required before commencement of any work is to be undertaken. If you are uncomfortable entering your details into the above form, please place an "x" in each of the required fields for credit card details. We will contact you upon confirmation of your booking and request card details over the phone as security towards payment. At the time of billing you may choose to pay via EFT, cash or credit card.
I agree to the Terms and Conditions
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