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Wet Berth Rental Request

Wet Berth Rental Request

CUSTOMER DETAILS
Name*
First Last
Company Name
Agent
Address*
Street Address City ZIP / Postal Code
Phone*
Email*
VESSEL DETAILS
Vessel Name*
Vessel type
- Yacht
- Launch
- Charter
- Multi-hull
Length overall*
(in meters)
LOA = LENGTH OVERALL (includes all appendages fore & aft)
Beam*
(in meters)
Draft*
(in meters)
Hull Colour*
Hull material*
Do you have holding tanks?*
- Yes
- No
Untitled
- Grey water
- Black water
- Black water treatment
LIVE ABOARD / COMMERCIAL OPERATOR
Do you wish to stay aboard your vessel?*
- Yes
- No
Do you wish to undertake commercial operations*
- Yes
- No
INSURANCE DETAILS
You will be required to present an insurance certificate prior to acceptance.
Insurer*
Policy No.*
Issue Date*
Date Format: DD slash MM slash YYYY
Expiry Date*
Date Format: DD slash MM slash YYYY
ELECTRICAL CERTIFICATE
You will be required to provide a copy of EWoF prior to connection.
Do you wish to connect to shore power?*
- Yes
- No
H&S Form
Consent*
I have completed and understand the Empire Capital health and safety induction.*
Warrant No.*
Issue Date*
Date Format: DD slash MM slash YYYY
Expiry Date*
Date Format: DD slash MM slash YYYY
Terms and Conditions
Consent*
I acknowledge receipt of a copy of the marina rules and terms of berth occupation and agree to be bound by such terms and rules. The information collected will be held for the use of Pine Harbour Marina Limited, Pine Harbour Marina Management Limited and Pine Harbour Marine Services Limited.*
Signed on behalf of Renter*
Date*
Date Format: DD slash MM slash YYYY
RENTAL PERIOD REQUEST
Berth rental fixed period from
Start Date
Date Format: DD slash MM slash YYYY
To
End Date
Date Format: DD slash MM slash YYYY
OR
Monthly periodic rental beginning
Start Date
Date Format: DD slash MM slash YYYY

Berth rental is subject to availability and written confirmation/approval from Pine Harbour Marina.

office@pineharbour.co.nz
+64 9 536 4720
190 Jack Lachlan Drive, Pine Harbour, Auckland, New Zealand

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