*Telephone *Email
*Boat Name: *Boat Make:
Anticipated Haul Date: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 20122013201420152016
*Will Madaket Marine pick up your boat to be decommissioned? Madaket Marine does NOT winterize my boat No, I will deliver my boat to Madaket Marine Yes, please retrieve my boat on the date indicated above
If so, where is the pick-up location? Madaket Marine Valet Madaket Marine Dockage Madaket Marine Rental Mooring Mooring: Other:
*Where are the boat keys located? The keys will be left in the boat
*Please select any work you would like done (note: all work listed here is considered "normal prep") Decommission the motor Powerwash Shrinkwrap
*Are there any canvas or cushion repairs needed? Yes
*Are there any fiberglass repairs needed? Yes
*Do you own a trailer for this vessel? Yes
*Is Madaket Marine your mooring handler? Yes
*Is your boat stored at Madaket Marine during the winter Yes, I have received and signed my storage agreement No, I will pick up my boat once it has been decommissioned
Is there any work you would like done that is not otherwise indicated on this form?
*I hereby authorize Madaket Marine to perform all services as indicated on this form.