Boat owner or responsible party: __________________________________________________

Address: ____________________________________________________________________

___________________________________________________________________________

Home Phone: ________________ Business: ________________ Cell: ____________________

Boat Name: ______________ Make: ____________ Length: ____ Model: _________________

Registration #: ___________ Plate # on trailer: ___________ Make of truck or car: ____________

STRIPER DOCKAGE & RAMP PASS WILL BE FOR THE MONTHS OF APRIL & MAY ONLY. APRIL WILL BE BASED ON WEEKS (DUE TO WEATHER). MAY WILL BE BASED ON FULL MONTH. * No refunds on striper dockage or ramp/land passes.

$ 200.00 per/mo. for in-water dockage...................................................$________________

$ 75.00 per/week for in-water storage....................................................$_______________

$ 150.00 per/mo. for ramp pass and land storage.....................................$_______________

$ 75.00 per month for ramp pass (boat & trailer leave the marina at night..$______________

* Ramp pass is for unlimited usage anytime for the boat that is listed on this form

Mail check or charge card information to:

Certified Marine Service, Inc.
PO Box 237
Connelly, New York 12417

 

Signature: ______________________________________________ Date: ______________

E-mail address: ______________________________________________