Work Request and Approval Form

Challenor Marine > Work Request and Approval Form

Your Details

First Name

LastName

Phone

Vessel Details

Make

Model

Boat Name

Rego Number

Engine Details

Engine Brand

Engine Model

Engine Year

Engine Serial Number

Drive Type e.g. Shaft, Sterndrive or Outboard

Details of Work Required

Details

Payment Details

Cardholders Name

Card Number

Expiry Date (MM/YYYY)

CCV (Last 3 Digits)

Billing Address

Street Number

suburb

State

Postcode

I agree to the Terms and Conditions
I authorise the work requested above and agree to pay for labour, spare parts and materials required for that purpose at the Challenor Marine Services Pty Ltd current rates and prices. I authorise Challenor Marine Services Pty Ltd to debit my Credit Card on completion of work using completed credit card authorisation, Challenor Marine Services Pty Ltd 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 Challenor Marine Services Pty Ltd or its employees. I agree to pay Challenor Marine Services Pty Ltd reasonable storage charges if delivery of the vessel is not taken within two days after notice is given by Challenor Marine Services Pty Ltd 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 or Cardpayment (We no longer accept cash payments).