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ON-CALL PUMP-OUT SERVICE

YOUR INFORMATION
First Name:
Last Name:
Boat Name:
Harbor:
Assignment:    (Dock-Slip, star dock or mooring can location)
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
  

 

Boat owner is responsible for maintaining a properly functioning air vent on all holding tanks.  Service will generally 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.

 

This form and its contents are encrypted and communicated in a secure format backed by VeriSign.