Name (required):
Email (required):
Phone (required):

Vessel Name:
Vessel Length (feet):
Vessel Beam:
Vessel Make/Brand:
Slip Request Dates:
Details & Services Required:

First Name (required):
Last Name (required):
Your Email (required):
Work Phone:
Home Phone:
Mobile (required):
Fax:

Billing Address
Address (required):
Suburb (required):
Post Code (required):

Vessel Name:
Vessel Length: feet
Type:
Drive Type: Shaft singleShaft twinSterndrive singleSterndrive twinOutboardOther
Keel Type:
Rego:
Location of Keys:
Slip Request Date:

Details

Is towing required? (Provide bay and number):
YesNo
Towing details (Provide bay and number):
Price inc. GST: $
"Slip, Waterblast & Antifoul:
YesNo
Price inc. GST: $
"Slip Only/Slip & Clean:
YesNo
Price inc. GST:
"Acid Wash:
YesNo
Price inc. GST:
"Anodes:
YesNo
Price inc. GST:
"Prop Speed:
YesNo
Price inc. GST:
"Prime Bare Areas:
YesNo
Price inc. GST:
"Topside Polish (waterline to gunwale):
YesNo
Price inc. GST:

Other Comments:

Payment

Cheques and Cash are not accepted.

Credit Card MastercardVisa
Credit card holders name:
Credit card number (no spaces):
CCV:
Expiry Date:
JanFebMarAprMayJunJulyAugSepOctNovDec2023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

I authorise the work requested above and agree to pay for labour, spare parts and materials required for that purpose at the GBM current rates and prices. I authorise GBM to debit my Credit card on completion of work using completed credit card authorisation, The Marina shall not be responsible for the loss or damage to the vessel, it's accessories or contents whilst berthed or being driven in connection with the work being authorised unless caused by the negligence of GBM or its employees. I agree to pay GBM reasonable storage charges if delivery of the vessel is not taken within two days after notice is given by GBM that the work has been completed.