EMG Customer Service Request Form

Customer Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Eclipse Marine Group Service offers Text Messaging as a method of communication with our customers. Do we have your permission to contact you via text?*

YesNo
DISCLAIMER: Text communication will be used regarding your service needs only. Standard text messaging rates from your wireless carrier may apply. Any costs related with receiving a text message are the responsibility of the individual receiving it. Check with your cellphone provider for details on receiving text messages (SMS). To opt out of texting at any time, reply STOP.
Choose Your Eclipse Marine Group Service Location*
Boat & Engine Details
Please enter "N/A" if unknown or not applicable.
Boat Make*
Boat Model*
Boat Year*
Boat HIN / Serial Number
Engine Make*
Engine Model / Horsepower*
Engine Year*
Engine Serial Number
Service Request Details:
Type of Service Requested: (Check as many as needed)*

Routine / Preventative MaintenanceAccessory or Part Installation / UpgradeBoat Detailing / Toon Cleaning / Bottom CleaningDe-Winterization / SummerizationEngine Diagnosis and/or RepairManufacturer RecallMercury Engine RepowerMercury Engine Repower QuoteStructural or Cosmetic Boat Repair (incl. hull, electronics, plumbing, etc.)Trailer Maintenance, Repair or InstallWinterizationOther / Unknown
You chose, "Winterization." For Winterization Service Requests, please click the link below to the location where you would like to have this service. You will be taken to a seperate form to complete this request.
You chose, "Other/Unknown." Please describe your service request needs:*
How Will You Bring In Your Boat?*
You Chose, "Other." Please describe how you will bring your boat in for service:*
Where Will You Leave Your Keys?*
Additional Comments or Questions for the Service Team?
By clicking this box, I acknowledge and accept the Terms of Use, the Privacy Policy, and the Cookie Policy, and agree that my information may be transferred to the U.S. if I am outside the U.S.*

I Agree
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