Service Request Form
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1POPEYE'S PUMPOUT CO.
FAX THIS FORM TO: 310-822-8312
eMail to :
Clean, quiet, reliable...
13900 PANAY WAY DS 50, MARINA DEL REY, CA 90292 TEL. 310-822-8312
SERVICE REQUEST
Popeye, please pump my holding tank!
sailboat
(
)
Boat make :
powerboat
(
)
houseboat
(
)
Size of boat:
ft.
Number of holding tanks:
Total volume:
Gallons
Location of deck pumpout fitting(s):
right side (
)
front
(
)
left side
(
)
midship
(
)
back
(
)
LOCATION (Basin, Dock - Slip number):
___________________________
Boat Name:
_____________________________________________
/ MONTH
I request Popeye's to pump out my holding tank(s):
every month
(
) FEE $
/ MONTH
bimonthly
(
) FEE $
every other week
(
) FEE $
/ TRIP(2-3perMonth)
/ MONTH
every 10 days
(
) FEE $
/ MONTH
4 times per month
(
) FEE $
EVERY WEEK
(
) FEE $
/ TRIP(4-5perMonth)
other
(
) FEE $
/ …………
explain...: ___________________________________________________________
Boat owner's NAME:
Telephone:
home #
mobile #
fax#
eMail:
Send me an INVOICE to this ADDRESS:
______________________________________________
______________________________________________
Disclaimer: Boat owner is responsible to maintain black and grey water holding tanks. Plumbing must be in good condition.
Tanks should never be overfilled, air vents must never be clogged.
I understand and agree that Popeye's Pumpout Co. is not responsible for any damages arising while pumping out my vessel.
I AGREE, START SERVICE - Signature:
________________________________________________
Today's date:
___________________________
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