Central Connecticut Sea Tow
P. O. Box 495
Old Saybrook, CT 06475
Tel: 860-395-0405 or 203-488-3442
Sea Tow Membership Application
Annual Fees - Gold $149
Complete, then mail or
fax this form to us at: 860-395-1146
Applications Type:
New
Renewal #
_____________________________________________
Membership Type:
Gold
Dealers Only
[Free 60-day Trial Membership]
Applicant:
_______________________________________________________
Phone:
(_____)___________________________________________________
Address:
________________________________________________________
City / Town:
_________________________
State:
_____
Postal Code:
_________
Vessel Information
Home Port/Marina:
____________________________________________________
Year
:
___________
Length:
__________
Make
:
___________________________
Name of Vessel:
_______________________________________________________
Power
Inboard
Single Engine
Sail
Outboard
Dual Engine
I/O
Payment Information
Pament Method
(check one
)
Check
Visa
MC
AMEX
Credit Card #:
_______________________________________________________
Name On Credit Card:
_______________________________________________________
Expiration Date:
__________________________
Month
________
Year_____________
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Sea Tow Central Connecticut is a Franchisee of Sea Tow Services International. Sea Tow, "Your Road Service At Sea", Sea Care, and Protected are registered trademarks of Sea Tow Services International®.