Slips, Sails and Scenic Views

*Desired Move-In Date:

Personal Information

*Registered / Documented Owner(s):

Partner Name (if Applicable):

*Billing Address:

*City:

*State:

*Zip:

*Home Phone:

Business Phone:

Cellular Phone:

*Email:

Legal Owner / Lender Information

Name (Individual, Bank, Finance Co.):

Address:

City:

State:

Zip:

Reference Agent / Loan #:

Phone:

If Vessel Is Corporately Owned

State Of Incorporation:

Date:

Vessel Information

Name Of Vessel:

Make / Builder:

Type: Select:PowerSail

Year Built:

*Length Overall:

*Beam:

Draft:

Engine: Select:GasDiesel

Holding Tank:

Do You Have Non-Toxic Bottom Paint? YesNo

Registration or Documentation Number:

Hull: Select:WoodFiberglassSteelColor

*Request Live-Aboard? YesNo

# Of People:

Pets:

Present Location Of Vessel

Marina:

Location:

Contact Name:

Phone:

*Do You Plan To Charter The Vessel? YesNo

*Are You Capable Of Handling The Vessel In The Marina In A Safe Manner? YesNo

If No Please Explain Here:

Where Did You Hear About Us?

Insurance Information

Company:

Agent / Agency:

Phone Number:

Policy Number:

Amount Of Liability (Minimum $500,000 required):

Exp. Date:

Utility Requirements

Electrical Voltage:

Amps: