This form must be fully completed by all potential Marina Members.
Please fill out and Fax to (928) 467-2862 or mail to
HC02 Box 4850
Roosevelt, AZ 85545
If you have any questions please call (928) 467-2245
Please note that this is an INQUIRY for storage, once completed our contract administrator will contact you about availability of slips and dry storage.
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Name or Names that are to appear on the contract:
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First Name/ Business Name:
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Last Name:
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Storage of Interest:
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Slip Payment Billing Address:
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Street:
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City:
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State:
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Zip Code:
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Contact Numbers:
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Home Phone:
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Work Phone:
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Cell Phone:
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Other Phone:
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Fax Machine:
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Email Address:
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Home Address (if different from billing address):
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Street:
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City:
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State:
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Zip Code:
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Watercraft / Trailer Information:
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Boat Make:
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Boat Model:
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Boat Year:
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Boat actual overall length(ft & in)
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Color of Boat:
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Hull ID number:
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Registration Information:
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State:
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Coast Guard Numbers:
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Lien Holder:
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Insurance Provider:
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Policy Number:
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Trailer Make:
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Color:
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Number of Axles:
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Trailer VIN:
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Trailer Plate Number:
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State:
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Other Parties in ownership of boat (MAXIMUM of 3):
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Name:
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Phone Number:
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| Name: | Phone Number: | |
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Name:
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Phone Number:
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Roosevelt Lake Marina operates under permit with the Tonto National Forest.
Copyright © 2008 Antelope Point Holdings, LLC All rights reserved
Website by MWright and Jon Marks [ididthis2]