Streamline Diving Northwest LLC
Client intake form
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Last Name
*
First Name
*
Phone Number  *
Email *
Vessel Location (City, Marina, dock, slip # and/or precise location)
*
Vessel name
*
Make and Model of vessel
*
Length Of Waterline? (LWL)
*
Length Over All? (LOA)
Beam
*
Displacement (Tons) *
Type of boat?
*
Type of use
*
Required
How often is vessel used/moved?
(Monthly, weekly, summers, half year, ect)
*
Hull Construction material?
*
Type of keel
*
Any Sharp objects? (rope cutters, keel cutters, kelp cutters, ect.)
*
Dual Rudder or propellers
Thrusters?
Do thrusters have Antifouling coating?
Clear selection
Type of Antifouling paint?
*
Brand and model of Antifouling
*
Approximate date of last bottom paint application
*
MM
/
DD
/
YYYY
Next planed haul out (anti-fouling repaint)
MM
/
DD
/
YYYY
Zinc type, size, and number of anode(s) (if known)
What type of Power Drive?
Clear selection
Propeller type
Clear selection
Propeller coating or anti fouling?
Clear selection
Number of Thru-hulls to be inspected or cleaned if applicable or known
Clear selection
Any other information that we need to know? (preferred cleaning method, damage, missing parts, Idiosyncrasy's, ect)
About how many cleanings do you think your boat needs within the next 365 days?
How did you hear about us?
Make sure you check your junk mail for our reply.
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