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DELPHIA CHARTERS-APPLICATION TO CHARTER

PORT CREDIT HARBOUR MARINA, 1 PORT STREET EAST, MISSISSAUGA, ON, CANADA, L5G 4N1

Ph:905-891-8207         Fax : 905-891-3059

info@dycc.ca

IMPORTANT!!! This document must be completed in full. Do not leave any blanks. If not applicable, indicate N/A.  This application is required for each charter, it will be kept on file for our reference and insurance purposes.

A- CHARTERER INFORMATION

Charterer’s name:

Address:

Home Phone:

Business Phone:

Fax:

E-mail address:

Age:

Occupation:

Employer:

B- CHARTER INFORMATION

Requested Charter Dates:

Arrival Date:

C- SKIPPER REQUEST

Skipper Requested: YES      NO

D- SKIPPER INFORMATION

If you are not requesting a Skipper and you are not the skipper, please fill out this section.

Skipper’s name:

Address:

Home Phone:

Business Phone:

Fax:

E-mail address:

Age:

Occupation:

Employer:

E- ADDITIONAL SERVICES (Extra charges)

Requesting dinghy / outboard motor:

YES     NO

YES     NO

F- EMERGENCY CONTACTS

Name:

Phone:

G- CREW LIST

Name

Age

Address

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