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ON-CALL PUMP-OUT SERVICE
YOUR INFORMATION
First Name:     Last Name:
Address1:
Address2:
City: ZIP:
Phone (Home):     (Work):      (Cell):
eMail:
BOAT INFORMATION

Boat Name:    
Harbor:    
Assignment:     (Dock-Slip, star dock or mooring can location)    
Boat Length:    
Boat Type:    
Number of Tanks:    
Estimated Size of Tank(s):   Gallons    
Number of Pump-Out Fittings:    
Location of Fittings:

Fitting 1:

Fitting 2:

Fitting 3:

   
SERVICE REQUESTED

Requested Date:     On Call Service: $25.00 per service More than one pump-out fitting: $5.00 per fitting  
COMMENTS
Comments:
PAYMENT INFORMATION

 

Major credit cards accepted with a $25.00 electronic transaction fee on charges greater than $1,000.00

 
Name on Card:  
Number:  
Expiration Month / Year:        CCV   
  

Service will be provided based on availability.

 

Boat owner is responsible for maintaining a properly functioning air vent on all holding tanks.  Service will be provided on weekdays. For service route and weather conditions, service provider reserves the right to determine the day of week that service will be provided.  Every effort will be made to accommodate Boat Owner under special circumstances, including emergency situations, service required immediately prior to departure for an extended cruise, or other special requests of Boat Owner to adjust service.

 

By submitting this form I understand that I will be responsible for all charges associated with the service requested.

 

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