84
L510010-11
FORMS - 19
PROBLEM NOTIFICATION OR INFORMATION REQUEST FORM
IMPORTANT: All blanks MUST be completed to insure proper identifi cation of your engine which is necessary to
properly understand your request.
When completed, mail this form to: Pleasurecraft Marine
PO Drawer 369
Little Mountain, SC 29075
Engine Model Engine Serial Number Gear Serial Number
Owner Information
Name Telephone ( )
Address
City State Zip
Selling Dealer
Dealers Address
Date of Purchase Boat Make Length Type
Gentlemen, I would like to inform you of a problem I have experienced with the above engine. My problem is:
My boat is located at
Address Telephone ( )
City State Zip
Requestors Signature Date
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