Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone Number

Home phone number

Form of Proof of ID

eg Drivers licence number

Vessel Name

Vessel Type

Power, Multi-hull, Ketch, Yacht etc

Vessel Registration Number

Vessel Hull Material

Fiberglass, Steel, Cement, Wood etc

Vessel Length Overall including Bow Sprits and Davits

Beam at widest point

Draught

Weight

Propulsion

Select

Fuel Type

If other, please list

Proposed arrival date

Proposed departure date

Insurance

Please check below to indicate you have emailed a copy of the current insurance for your vessel to [email protected]. All vessels require proof of insurance (including salvage cover) and registration in order to hold berth in this marina.

I have emailed Insurance Certificate of Currency

Insurance Company

Insurance Policy Number

Insurance expiry date

Notes / Comments

Terms & Conditions

I have read and agree to the terms and conditions of the Mooring Licence (link below)

Mooring Licence terms & conditions

Mooring Enquiry

Pacific Harbour Marina