Dry Stack Request

Customer Details
Name*
First Last
Company Name*
Agent*
Address*
Street City Suburb Post Code
Postal Address*
Phone*
Home
Phone*
Work
Phone*
Mobile
Email*
Vessel Details
Vessel Name*
Vessel make/model*
Length overall*
(in meters)
LOA = LENGTH OVERALL (includes all appendages fore & aft)
Hull Colour*
Hull Material*
Fuel Type*
- Petrol
- Diesel
Complete H&S Induction*
- Yes
- No
H&S Form
Trailer Storage
Will you require trailer storage?*
- Yes
- No
Trailer storage will incur an additional charge.
Trailer rego*
Make*
Serial Number*
Length overall*
Insurance Details
You will be required to present an insurance certificate prior to acceptance.
Insurer*
Policy No.*
Issue date*
DD slash MM slash YYYY
Expiry date*
DD slash MM slash YYYY
Electrical Certificate
Will you require unattended power connection while on work cradle?
Warrant No.*
Issue date*
MM slash DD slash YYYY
Expiry date*
MM slash DD slash YYYY
You will be required to provide a copy of EWoF prior to connection.
Terms and Conditions
Consent*
I acknowledge receipt of a copy of the marina rules and terms of the Dry stack and agree to be bound by such terms and rules. The information collected will be held for the use of Pine Harbour Marina Limited, Pine Harbour Marina Management Limited and Pine Harbour Marine Services Limited.*
Signed on behalf of Renter*
Date*
DD slash MM slash YYYY
Rental Period Request
Dry Stack rental fixed period from*
MM slash DD slash YYYY

Start date (12 month period beginning)

Dry Stack is subject to availability and written confirmation/approval from Pine Harbour Marina.

Customer Details