Vessel Storage License Agreement (Effective October 1, 2021)Vessel Storage License Agreement • September 1st, 2021
VESSEL OWNER & OPERATOR Owner Name Company Name Email Physical Address Home Phone City State Zip Cell Phone Billing Address Work Phone City State Zip Drivers LIC State/Country Number In Case of Emergency Phone # Email VESSEL DESCRIPTION Vessel Name Vessel Type Hull Identification Number Documentation or Registration# Vessel Make Model & LOD Year Color LOA (FT) Beam (FT) Height Weight Engines Engine Make Year INSURANCE INFORMATION Insurance Company Policy # Exp Date Policy Names PDR as Additionally Insured Yes No Broker Phone # Hold Harmless Agreement Yes No DOCKAGE/STORAGE CHARGES Description Total Amount Additional Information Initials Annual License Fee Above paid Monthly Subtotal $ ADDITIONAL EXPECTED CHARGES $ $ State Tax $ Total $
