Services Request Form
New Customer


Please take a moment to fill out the required fields on this page.
Once your information has been submitted and received by us we will contact you with an estimated date and time that our mechanic will be able to fulfill your request.


Our normal scheduling wait is approximately 2 weeks, so please book in as soon as possible!

Fields marked (*) are required.

Personal Information
*First Name
*Last Name
House Name
*No. and Street
*Parish			*Postal Code
*Telephone (H)			(W)
Cell Phone			Fax
*Email
Boat Information
*Boat Name
*Boat Make
*Boat Length
*Reg #			*Mooring #
*Boat Location
*Key Location (preferably on boat)
*Engines	Gasoline		Diesel
*Engine Make/Model
*Service Requested
	I hereby authorize the above repair work to be done along with the necessary materials. KM Marine Solutions and your employees may operate the unit herein described on any waterways or elsewhere for purposes of testing, inspection, or delivery at my risk. An express mechanic’s lien is acknowledged on above unit to secure the amount of repairs thereto. it is also understood that you will not be held responsible for loss or damage to unit (or articles left in or with the unit) in case of fire, theft, accident, inclement weather conditions, or any other cause beyond your control. Any invoice beyond 30 days will become a collection matter all cost will be at your expense. Invoices will be subject to late fee charges of 6.5% per month after 30 days.
*Authorised By