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Rosston Eddy Marina
Dock Space Application
170 Rosston Circle - Ford City - PA - 16226
724.763.1202 Phone 724-763-1218 Fax
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. You are
required to carry a minimum of $300,000 liability insurance coverage on your boat.
Your First Name
Your Last Name
Your mailing address
Email address
Cell Phone #
Home Phone #
Zip Code
Boat Information
Make of Boat
Year of Boat
Your Boat's Name
Length, including swim
platform, bow pulpit and
other overhangs
Registration #
Hull Identification #
Select One
Electric Needs
Boat Insurance Information
Boat Insurance Co. Name
Policy Number
Insurance Liability Coverage Amount
Insurance Agent's Name
Insurance Company Address
Insurance Agent's Phone #
Additional Comments, Questions or Suggestions
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.
Boat Owner's Name
Co-Owner's Name