Berth Application - Riverbank Marina

Vessel Owner: *

Note: Vessel owner must be listed exactly as on registration/title!

Email Address *

Mailing Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Residence Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone:

Work Phone:

Cell Phone: *

Driver's License Number: *

Employer: *

Position *

Employer Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Other Vessel Owners: *

Note: Any and all vessel owners must fill out a separate application

CF / Doc Number: *

Year / Make: *

Name: *

Model: *

Overall Length: *

Color: *

Vessel Power: *

Hull ID Number: *

Authorized Access

(Any person(s) that would be on the vessel without an owner on a regular basis.)

Name(s) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone *

Emergency Contact

(In case something happens to you and/or the boat. Someone who doesn't live with you.)

Name(s) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone *

Previous Marina Where Berthed: *

Contact: *

Phone: *

Are you interested: *

Covered?
Uncovered?

Are you interested: *

Yearly?
Monthly?

Are you interested in renting a dock box? *

Yes
No

Fee for dock box is $15 /month for yearly tenant. $25 /month for monthly tenant.

Vessel Arrival / Start Date? *

Number of gate keys requested: *

Please note there is a $25 /key nonrefundable fee.

Have you ever been a tenant or guest at Riverbank before? *

Yes
No

How did you hear about Riverbank Marina?

Other Comments:

I hereby certify that all the foregoing information I have supplied in this application is correct and complete and that all vessel owners are listed above. Furthermore, I understand that any misrepresentation, falsification, or material omission of information in this application may result in termination of the license agreement at the sole discretion of Riverbank and its owners. I release all parties and persons from any and all liability of any damages that may result from furnishing such information to Riverbank, as well as from the use or disclosure of such information by Riverbank or any of its agents, associates, or representatives.

Signature of Applicant *

First

Last

Date *