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Boat owner or responsible party: _________________________________________________________Address: ___________________________________________________________________________
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Home Phone: _____________________ Business: ____________________Cell: ___________________
Boat Name: _______________ Make: _______________ Length: _____ Model: ___________________
Registration #: ________________ Plate # on trailer: _____________ Make of truck or car: ___________
STRIPER DOCKAGE & RAMP PASS WILL BE BASED ON FULL MONTHS OF APRIL, MAY OR BOTH, BUT NOT FOR SPLIT MONTHS. *No refunds on striper dockage, land or in-water.
$350.00 per/month for in-water dockage. .........$________________
$200.00 per/month for ramp & land storage...... $________________
* Ramp pass is for unlimited usage anytime for the boat that is listed on this form.
* MUST SUBMIT PROOF OF INSURANCE.
* MUST SUBMIT COPY OF COAST GUARD LICENSE
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Date Signature of Boat Owner or Responsible PartyE-mail Address: ______________________________________________