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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Telephone*Mobile Telephone*Email* Are you a Mylor berth / contract holder? Yes No Vessel name*Vessel current location*Make of boat*Type of boat*Keel type*L.O.A. (incl. bowsprit)*Beam*Draft*2 HAUL OUT DATEEarliest haul out date* Date Format: DD slash MM slash YYYY Where possible, we will endeavour to give you the earliest date requested. But to avoid disappointment please call the office to make a provisional lift booking: 01326 372 121. Please note: If you have a rope strop on your mooring, this will automatically be removed, cleaned, stored and refitted at a cost to you. A full list of our services & charges are available on request or on our website www.mylor.com3 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 all that apply after your vessel lift* Place in hired MYH cradle Place in owner’s cradle Onto owner's trailer Fit beaching legs Shore up Location of trailer (if applicable)Pressure wash hull Pressure wash hull Rig 'strong back' and attach covers Rig 'strong back' and attach covers Covers - Owners to supply? Yes No Location of covers Refuel vessel prior to haul out (diesel only) Do not tick if tank cleaning work is required. (Refuelling cannot be done once the vessel is ashore. A Diesel Duty Form will need to be completed).Number of fuel tanks Remove gas bottles, label and store (obligatory) Gas bottles must not be left aboard when ashore. If not ticked, owner must remove bottles.Number of gas bottles4 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 which is also available to complete on our website or download and print 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 Owner to disconnect disconnect Carry out mast electrical safety check 5 SERVICE WORKPlease tick all the following services that you would like carried out: Seacocks: strip, clean and service Bilges: clean out and dry Heads: strip, clean and service Gas systems: check and / or repairs 6 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 makeEngine model NoGearbox makeGearbox model No To include stern drive service (If your engine is an outboard this work has to be done out of the water)Gearbox make: Rope cutter: service Shafts / propellers: clean Anodes: check all when out of the water (for corrosion and change if necessary) Gearbox model No: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 Generator make:Generator model No:7 ELECTRICAL WORKElectrical Work In water anode corrosion check (to test performance and bonding / anode efficiency) 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) Windlass: strip, clean and service Batteries: remove, store and charge 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 Work8 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 9 below. MYH to connect the vessel to electricity Hire MYH Cable Customer to supply electricity cable 9 MYLOR EQUIPMENT HIREEquipment is available to hire from Mylor Yacht Harbour. Monthly hire charges apply. Dehumidifier: set up and connect (Please note: dehumidifiers are set up to drain into the vessel's sink). Hire MYH dehumidifier Confirm location of sink drain seacock for staff to open: Heater: set up and connect Hire MYH heater 10 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 11 IMPORTANT INSTRUCTIONS FOR CUSTOMERSImportant Instructions For Customers* Please ensure that boat / trailer keys are provided to the MYH office at least 1 week prior to boat lift Please ensure that boat name is clearly visible on hull or cradle/trailer Please check you have valid insurance cover afloat/ashore 12 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* Date Format: DD slash MM slash YYYY 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.