Dockage & Fuel
Customer Information
Name _______________________________________________________
Address______________________________________________________
City _______________________________ State _______ Zip __________
Home Phone _________________ Work Phone ______________________
Cell Phone _______________ Emergency Contact Number _____________
E-mail Address ________________________________________________
Please print names of Co-Owners or Family Members
Name_________________________ Relationship_____________________
Name_________________________ Relationship_____________________
Name_________________________ Relationship_____________________
Boat Information
Year __________ Make _________________ Model ___________________
Length ___________ Beam__________ PA Registration #_______________
Boat Name _____________________________________________________
Insurance Information
Agent Name _________________________ Agent Phone _______________
Carrier __________________________ Policy Number _________________
Effective Date __________________ Cancellation Date _________________
For Dockers not requiring electric or water
Total Rate is $ 32.00 per foot (20 foot Minimum)
$28.00 per ft if paid in full by 2-10-2012 $30.00 per ft if paid in full by 3-10-2012
Boat size _______ X $( ) = ________________
For Dockers needing electric or water
Total Rate is $ 42.00 per foot (25 foot Minimum)
$38.00 per ft if paid in full by 2-10-2012 $40.00 per ft if paid in full by 3-10-2012
Boat size _______ X $( ) = ________________
Tenant(s) certify that the printed matter on both front and back of this agreement has been read and the terms and conditions set forth herein are fully understood. Tenant(s) further certify that they have examined the space in which the subject boat is to be placed and find it suitable and acceptable. Tenant(s) further acknowledge and hereby agree that the terms on the back of this agreement, including the releases and waivers in paragraphs 6, 16, and 17, are a material part of this BOAT SPACE RENTAL AGREEMENT and are incorporated herein to the BOAT SPACE RENTAL AGREEMENT as fully as though they were set forth at length on the front of this agreement and for the purposes hereof the terms “LANDLORD” and “LESSOR” are interchangeable and the terms “tenant” and “lessee” are interchangeable. Tenant(s) understand that a dock space will be reserved only if a NON-REFUNDABLE DEPOSIT OF $250.00 OF THE DOCKAGE/STORAGE FEE HAS BEEN MADE BY FEBRUARY 10, 2012. I (WE) SIGNATURE(S) ON THE ABOVE APPLICATION VERIFIES THAT I (WE) INTEND TO BE LEGALLY BOUND, EXECUTE THIS AGREEMENT THIS DAY____MONTH____YEAR_____
Returning customers, please list your slip number from last year ________
Do you wish to have the same slip as last year? Yes or No
