Half Moon Inn Marina

*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 Number:

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 This 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

Electric Voltage:

Amps: