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2005 Dockage Contract
Yacht Registration Form
Yacht Name: _________________________ LOA_________
Home Port ___________________________ Beam________
Flag & Document # ___________________ Draft________
Est. Arrival Date _____________________ Est. Departure Date ___________
Captain _____________________________ Passport #____________________
HomeTelephone_____________________ E Mail________________________
Local (Venezuela) Telephone _________________ Sat Phone___________________
Crew ______________________________ Passport #___________________
HomeTelephone_____________________ E Mail________________________
Crew ______________________________ Passport #____________________
HomeTelephone_____________________ E Mail________________________
Crew ______________________________ Passport #____________________
HomeTelephone_____________________ E Mail________________________
Owner______________________________ Telephone_________________Fax_________________________
Address__________________________________________________________________________________
City, State, Zip, Country_________________________________________ E Mail _______________________
Contact Person (if different from owner)___________________________________
Phone ___________________Fax ________________Email_____________________
Bills to: (if different from owner)__________________________________________
Phone ___________________Fax ________________Email_____________________
Address____________________________________________________________________
City, State, Zip, Country_______________ E Mail _______________________
Information provided by______________________________ Date_______________
Terms and Conditions of Dockage are as listed in the Contract