Customer Application

This form is here for your convenience, as a way for you to send us relevant information. Please fill in whatever boxes apply to you.  Use the space at the end of the form to specify your needs.  We look forward to meeting you in person.

Application for:

Storage Marina Slip Mooring
Chandlery/
Fuel Dock
 
Customer File Information
Name
Street/P.O. Box
City
State Zip
Emergency Contact
Emergency Phone
Boat File Information
Boat Name
Registration Number
Manufacturer
Model Year
Length Beam Draft
Rig Color
 
Home Phone
Business Phone
Cell Phone
Fax
Email
 
Engine Serial Number
Dinghy Type Name
Registration Number
Dinghy Outboard Type Size

 
Boat File Information
Insurance Company Expiration Date
Where has the boat been serviced previously? How did you hear about us?
Additional Comments