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Rosston Eddy Marina
Dock Space Application
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170 Rosston Circle - Ford City - PA - 16226
724.763.1202 Phone 724-763-1218 Fax
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Thank you for your interest in keeping your boat at Rosston Eddy Marina. Please complete and submit this
application. Your application will be processed and, pending space availability, a contract will be sent to you. If it is
late in the season, a contact will be sent to you early the following year.
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Your First Name
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Your Last Name
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Your mailing address
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Email address
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Cell Phone #
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City
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Home Phone
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State
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Zip Code
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_____________________________________________________________________________________________
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Boat Information
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Make of Boat
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Year of Boat
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Length including swim
platform, bow pulpit and
other overhangs
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Your Boat's Name
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Registration #
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Beam
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Hull Identification #
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Propulsion Type
Select One
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Electric Needs
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______________________________________________________________________________________________
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Boat Insurance Information
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Boat Insurance Co. Name
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Policy Number
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Insurance Agent's Name
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Insurance Company Address
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Insurance Agent's Phone #
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______________________________________________________________________________________________
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Additional Comments, Questions or Suggestions
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By submitting this application, I am certifying that answers given herein are true and complete to the best of my
knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial history
and other related matters as may be necessary in arriving at any slip rental decision. I hereby release employers,
schools or persons from all liability in responding to inquiries in connection with my application. In the event of
acceptance, I understand that false or misleading information given in my application may result in eviction. I
understand, also, that I am required to abide by all rules and regulations of the Dockage License Agreement as well
as the rules and regulations as set forth by the management of Rosston Eddy Marina.
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Boat Owner's Name
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Date
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Co-Owner's Name
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Date
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