Ready to book your marina pen?

Exmouth Marina Pens

BOOKING ENQUIRY FORM

To apply for a one our our pens please fill in the form.

Owners Details

Owner's Full Name *

Date of birth

Model

Company Name

ABN/ACN

Residential Address *

City

State

Postcode

Postal Address

Same as residential address

Different to residential address

Mailing Address

City

State

Postcode

Mobile/Telephone

Email

Contact Details

Skipper

Other

Contact Full Name

Date of birth

Model

Company Name

ABN/ACN

Residential Address

City

State

Postcode

Postal Address

Same as residential address

Different to residential address

Mailing Address

City

State

Postcode

Mobile/Telephone

Email

Compliance & Insurance Details

Insurance Broker/Company

Public Liability for $10 Million Policy No: *

Public Liability Expiry *

Policy or Certificate of Currency Supplied

Electrical Certificate

N/A or

Certificate Number

Electrical Certification Expiry

Gas Certificate

N/A. or

Certificate Number

Gas Certification Expiry

Copies of Certificates can be supplied?

Yes

No

Intended Term of Stay

3 months or more?

12 months or more?

month(s)

week(s)

day(s)

From Date *

Time in *

To Date *

Time out *

Facility Services

Power

Fuel

Water

Declaration

I authorise Exmouth Marina Pty Ltd to invoice me for the Vessel Fees which are payable in advance for the above nominated period of stay. I acknowledge that the account payment terms for all additional facility services are strictly 30 days from the date of invoice. I declare that I am aware of and will comply with the Terms and Conditions, Electrical, Gas and Insurance Requirements.

By checking this box you agree to all of above

Name *

Signature *

Todays Date *

Thank you for completing this form.

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Once we receive we will get back to you with an update to your request.

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DOWNLOAD OUR FORM

Our pen details

Here are our pens, with sizes and numbers

Our pen fees

Pen width	Peak Season (Apr – Oct)	Low Season (Nov – Mar)
10m	$485 + GST per day	$260 + GST per day
11m	$575 + GST per day	$295 + GST per day
12.6m	$795 + GST per day	$380 + GST per day

Ready to book your marina pen?

Exmouth Marina Pens

BOOKING ENQUIRY FORM

Owners Details

Contact Details

Invoiced to:

Vessel Details:

Compliance & Insurance Details

Intended Term of Stay

Facility Services

Declaration

Our pen details

Our pen fees

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