FULL NAME *

COMPANY / VESSEL NAME

EMAIL ADDRESS *

PHONE NUMBER *

COUNTRY *
—Please choose an option—NetherlandsGermanyBelgiumFranceItalySpainUnited KingdomTurkeyPolandRomaniaBulgariaHungaryCzech RepublicSwedenNorwayDenmarkSwitzerlandOther

CITY / PORT / MARINA

EQUIPMENT TYPE *
—Please choose an option—Outboard MotorInboard Diesel EngineInboard Gasoline EngineCrate EngineTransmission / GearboxIndustrial PumpGeneratorHydraulic SystemOther

BRAND / MANUFACTURER *

MODEL NUMBER *

SERIAL NUMBER

YEAR OF MANUFACTURE

ENGINE HOURS (IF KNOWN)

LAST SERVICE DATE

CAN THE EQUIPMENT STILL RUN?
—Please choose an option—Yes — runs but poorlyYes — intermittent faultNo — will not startNo — seized / locked upNot tested — afraid to cause more damage

IS THE EQUIPMENT STILL INSTALLED?
—Please choose an option—Yes — installed in vessel/vehicleYes — installed but vessel is on the hardNo — removed and at workshopNo — removed and in storageNo — ready for pickup/shipping

PREFERRED SERVICE TYPE
—Please choose an option—On-site / Mobile TechnicianWorkshop Repair (bring to us)Remote Diagnostics / Video ConsultationParts Supply Only — Self RepairUnsure — Need Advice

PREFERRED TIMEFRAME
—Please choose an option—ASAP — Vessel/vehicle strandedWithin 1 weekWithin 2 weeksWithin 1 monthFlexible — Planning ahead