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SCHEDULED PUMP-OUT SERVICE SIGN UP
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 Type:   Rates Per Service Rate* Flat Season Rate**
Start Date:     Weekly Service $20.00 $425.00
End Date::     Every Other Week Service $24.00 $250.00
     

 * There is an additional charge for more than one pump-out fitting of $5.00 per fitting and additional charges for pump out of more than 50 gallons per service.

** There is an additional seasonal charge for more than one pump-out fitting of $100.00 per fitting for Weekly Service and $50.00 per fitting for Every Other Week Service and additional charges for pump out of more than 50 gallons per service.
COMMENTS
Comments:
 


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.

All charges will be invoiced on a monthly basis and are due 30 days from the invoice date.

Any changes to the requested service must be submitted at least 7 days in advance of the effective change either

by email at honeyjug@westrecchicago.com or by phone at (312) 617-7017.

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

 

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