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Name *

First

Last

Address *

Street Description: Number & Name

City *

State *

Zip Code *

Email *

Phone Number *

Date for Delivery – Leave: *

Desired Destination Date *

Delivery From *

Please specify marina/yacht club/berthing location, city, state, country for vessel.

Delivery To *

Please specify marina/yacht club/berthing location, city, state, country for vessel.

Desired Return Date

Average Cruising Speed *

Please describe speed in knots.

Will you or any passengers be joining us? *

Yes
No

Please Specify Details of Passengers If Necessary

Vessel Name *

Builder / Manufacturer *

Year Commissioned *

Registration Information - Country/State *

Registration Information - Registration Number *

Documentation Number *

Vessel Power Sources *

Sail
Monohull
Catamaran

Vessel Length *

Vessel Beam *

Max Draft (with Keel & Rudder(s) *

Maximum Height above waterline including tower, mast and/or antenna(s) for clearance *

Indicate Feet or Meters

Is Vessel Ready to make a passage? *

Yes
No

If No, Please Explain.

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