Questions marked with an * are mandatory and must be completed in order to submit this form.1 CUSTOMER & VESSEL DETAILSName* First Last Address* Street Address City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home Telephone*Mobile Telephone*Email* Are you a Mylor berth / contract holder? Yes No Vessel name*Vessel current location*Class of boat*Type of boat*Keel type*L.O.A. (incl. bowsprit)*Beam*Draft*2 HAUL OUT DATESEarliest haul out date* Latest haul out date* Where possible, we will endeavour to give you the earliest date requested. Please allow at least seven working days between these dates.3 HAUL OUT INSTRUCTIONSAre the lifting locations clearly marked? Yes No PLEASE NOTE: In the absence of any lifting marks we will use our best judgement. No liability can be accepted for any consequential damage.Please indicate which drive you have* Outdrive No under hull drive Sail drive Shaft drive Please tick as appropriate* Haul out and place in hired MYH cradle (1) Haul out and place in owner’s cradle (2) Haul out onto owner's trailer Haul out and fit beaching legs (3) Haul out and shore up (4) PLEASE NOTE: (1) A monthly hire charge of £53 applies. (2) Owner’s cradle must be in satisfactory condition. If cradle is found to be unsatisfactory, a yard cradle will be used at an additional cost. (3) This will incur an additional 1/2hr labour charge (£23.40) unless carried out by owner within 24 hours. (4) Masts can only be left in situ with a bilge keel or beaching legs.Location of trailer (if applicable):*Pressure wash bottom Pressure wash bottom (£7.65/m)Rig 'strong back' and attach covers Rig 'strong back' and attach covers Refuel vessel prior to haul out Refuel vessel prior to haul out Do not tick if tank cleaning work is required. (Set charge of £26. Refuelling cannot be done once the vessel is ashore. A Diesel Duty Form will need to be completed)Remove gas bottles, label and store (obligatory) Remove gas bottles, label and store (obligatory) Gas bottles must not be left aboard when ashore. If not ticked, owner must remove bottles. (Set charge £16.50)4 MASTS & RIGGINGTick all that apply There is no mast Unstep mast Leave mast in situ (long / fin / lifting keel must have cradle / beaching / legs) Mast & Rigging Services are provided by Mylor Chandlery & Rigging Ltd. and will be invoiced directly from them. If you would like them to carry out your rigging work, please complete their Rigging Haul Out Instructions Form and either return it to them direct or, if you prefer, return it to us with this form and we will pass it to their office for you. MYH to disconnect mast electrics Carry out mast electrical safety check Owner to disconnect 5 SHORE POWER CONNECTIONShore power is available to all vessels ashore. Customers can make a connection themselves free of charge but if you require us to connect your vessel for you, or to set up any equipment, please indicate in Section 6 below. (A standard connection / set up fee of £35 applies).MYH to connect the vessel to electricity MYH to connect the vessel to electricity 6 MYLOR EQUIPMENT HIREEquipment is available to hire from Mylor Yacht Harbour. Monthly hire charges apply.Supply electricity cable Supply electricity cable (£15/month) Supply dehumidifier Supply dehumidifier (£20/month) Set up and connect dehumidifier Set up and connect dehumidifier PLEASE NOTE: dehumidifiers are set up to drain into the vessel’s sink.Confirm location of sink drain seacock for staff to openSet-up and connect heater Set-up and connect heater Supply heater Supply heater (£20/month) 7 SHRINK WRAPPINGShrink wrap film is used to completely protect boats of all sizes from the elements during winter storage or road transport. Optional extras such as air vents and zipped doors are also available.Tick the box to request a quote Please send me a quote for shrink wrapping PLEASE NOTE: If you have a rope strop on your mooring, this will automatically be removed, cleaned, stored and refitted at a cost of £62.8 ADDITIONAL YARD INSTRUCTIONS9 SERVICE WORK: ENGINEERING, ELECTRICAL, GRP REPAIRS, PAINTING & WOODWORKPlease tick all the following services that you would like carried out: Strip, clean and service seacocks Service rope cutter Clean out and dry bilges Check condition of cutlass bearing Strip, clean and service heads Clean shafts / propellers Strip, clean and service windlass Gas systems check and / or repairs Check all anodes out of water (for corrosion and change if necessary) ENGINE WINTERISATIONEngine winterisation includes a full engine service plus extra protection for the winter period. Please ONLY tick the box and complete the following fields if you require your engine to be winterised.Engine winterisation Engine winterisation Engine make:*Engine model No.*Gearbox make:*G.box model No.* To include stern drive service (If your engine is an outboard this work has to be done out of the water) AUXILIARY ENGINES & GENERATORSAuxiliary Engines & Generators Service outboard (Outboard service can only be conducted out of the water) Service / winterise the generator Store the outboard motor in the workshop (£49.00 per outboard) ELECTRICAL WORKElectrical Work Corrosion survey before haul out (check and report if the bonding system to the sacrificial anodes is intact) Electrical safety check / survey report (check electrical circuits, condition of wiring and operation of all systems and report) Refrigeration check / survery report (check operation of refrigeration units, including gas pressure and report) Remove and store batteries, charge batteries during the winter (£24.00 per battery) Number of batteriesLocation of batteriesADDITIONAL SERVICE WORKPlease provide details of any other areas of work you require on your vessel, to include engineering, electrical, GRP, painting and woodwork.Additional Service Work10 IMPORTANT INSTRUCTIONS FOR CUSTOMERSImportant Instructions For Customers* Please ensure that boat keys are with MYH office prior to lift Please ensure that boat name is clearly visible on hull or cradle/trailer Please check you have valid insurance cover afloat/ashore 11 CONFIRMATIONI hereby instruct Mylor Yacht Harbour Ltd and/or its contractors to carry out work detailed above and have read and agreed to the Terms of Business and the Mylor Yacht Harbour regulations.Signature of individual completing form:*Date* All our customer data is held & processed in accordance with the General Data Protection Regulations. Please see our statement & privacy notice at www.mylor.com/privacy-notice or contact Mylor Reception on 01326 372121, email email@example.com for more details or to obtain a printed copy.CAPTCHANameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.