Credit Application for Land or Slip Rent  
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Personal Information

Employer


Emergency Contact

Vessel Information

Trailer *

Documentation

Prior to slip assignment Kingsland Reach Marina requires the following documentation

 - Copy of current Virginia Registration card or Coast Guard Documentation

 - Copy of current Drivers License of Applicant

 - Copy of proof of insurance

To expedite the application process please attach the documents below, or fax them to (804) 795-5801 ASAP. If you are unable to send the documents digitally or by facsimile you can hand deliver them to marina staff during normal operating hour (Tue-Fri 9:00 am – 5:00 pm, Sat 9:00 am – 4:00 pm).

If you do not have digital copies of the documents now you can return to out site and submit them digitally through the Digital Documentation Submission Form found on the Marina web page or in the confirmation e-mail you will receive after submitting this application.




Additional Information

I intend to spend more then two nights per week or seven nights per month aboard my vessel while in port. *
The hull of my vessel is constructed of wood, or fiberglass coated wood. *
My vessel is a sailing vessel or has a draft of greater than 5 feet. *

Authorization / Signature

I Authorize Kingsland Reach Marina to verify the information provided on this form as to my credit and employment history. By typing my name in the following form field I am herby agreeing that all the information is correct and accurate, I understand that this will act as my digitial signiture, and will be used as such.  
Please fill your entire name in the box above, this will act as your digital signature.