EmailMe Form - Liferaft Servicing

Your Contact Information

Contact Name *

Please provide your full name

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

This is required for invoicing

Please Select *

This is my home address

This is a business address

Mobile Number *

Landline Number *

Email Address *

Confirm Email

Email Address for Invoicing

If we need to send the invoice to a different email address than the one given please add this email address

Confirm

Purchase Order Number or Your Reference

Please give if you have a purchase order number or reference that you would like us to use on invoicing.

Have you been a customer of Suffolk Marine Safety before?

Have you bought, hired or serviced items with us before?

Liferaft Information

Make

Model

Serial Number

What capacity is the Liferaft? *

Is the liferaft in a container or a valise? *

The purpose of the Liferaft *

Date of Manufacture

DD / MM / YYYY

Last Service Date

DD / MM / YYYY

Additional Information (Optional)

Please add any other additional information on the items last service

How many liferafts do you require a servicing? *

Service Preferences

Preferred Completion Date

DD / MM / YYYY

We do try an meet preferred completion dates, however please allow for lead times in the busy season between March - July.

Do you require an estimate? *

Delivery & Collection Information

Service items can be dropped into our shop Monday-Friday between 8:30-5:30 no appointment needed.

We also have collection points for customers ro drop off and return back any service items. Or we can arrange collection from a home/business or a marina.

Please provide an address if you have selected delivery to a business address, provide instructions if required for access.

Various collection/delivery charges apply.

Liferafts Coming in for Service

If arranging collection from a business or marina please provide an address.
If you have given a business address, provide instructions if required for access.

Deliveries to a marina, we kindly ask you check with the marina first if they are happy to take delivery and take a contact name.

Business or Marina Name *

Contact Name

Contact Number *

Please specify your preferred address if you have selected for us to collect item(s) to a business or marina address.

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Leave blank if we are collecting from the home or business address you have given as your contact details

Email Address

Confirm

Liferafts being returned after Service

If arranging service items to be deliver back to a business or marina please provide an address.

If you have given a business address, provide instructions if required for access.

Deliveries to a marina, we kindly ask you check with the marina first if they are happy to take delivery and take a contact name.

Business or Marina Name *

Contact Name

Contact Number *

Please specify your preferred address if you have selected for us to return item(s) to a business or marina address.

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Leave blank if we are delivering back to the home or business address you have given as your contact details

Email Address

Confirm

Additional Information

Please add any other information you think will be of importance to us.

PLEASE PRINT A COPY BEFORE SUBMITTING

We will in touch as soon as we can.