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| Contact Information: |
| *First Name: | | |
| *Last Name: | | |
| Address 1: | | |
| Address 2: | | |
| *City: | | |
| *State: |
*Zip: | |
| *Email: | | |
| *First Phone: | | | |
| Second Phone: | | | |
| Third Phone: | | | |
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| Referred By: | |
| If Other: | |
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| Boat Information: |
| Manufacturer: | | |
| Model Year: | | |
| Model: | | |
| Purchase Date: | | |
| State where Purchased: | | |
| Current Mileage/Hours: | | |
| Purchase Mileage/Hours: | | |
| Dealer: | | |
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| Warranties Recieved: |
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Warranty from hull manufacturer
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Warranty from engine manufacturer
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Warranty from dealer
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Other Warranty
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If yes, please provide details on all warranties.
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| Repair Information: |
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Total Number of times the vessel has been in for repairs
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Total Number of Days the vessel has been in for repairs
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Engine, Motor
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Hull, Body
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Water leaks
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Interior Body
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Electrical System
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Noises
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| Has the boat/vessel ever left you stranded? |
| If yes, please describe: |
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| Additional Information: |
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Submitting this form does not establish an attorney/client relationship – that will be established only upon our mutual agreement and execution of an agreement. Weisberg & Meyers, LLC has attorneys admitted to practice in Arizona, California, Colorado, Florida, Illinois, New Mexico, Oklahoma, Oregon, Texas and Washington and works with a nationwide network of consumer advocates in all other states. Accordingly, inquiries/submissions may be referred to and services may be performed by other attorneys associated with Weisberg & Meyers, LLC. As such, information sent in a request for a brochure/information may not be kept confidential and may not be protected by the attorney/client privilege, however, any such information will not be disseminated in any way or for any purpose other than that stated above.
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