Annapolis Charters
Annapolis Charters
Application for Charter
(Please Type or Print)
CAPTAIN INFORMATION Date: ___________________
Name (Captain): ______________________________________________
Home Address: _______________________________________________
City, State, Zip Code: __________________________________________
Phone Numbers (w/Area Code)
Home: ____________________ Work: ____________________
Cell: _____________________ Other:_____________________
E-mail: ______________________________________________________
CHARTER DATE(S) REQUESTED:
1st Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm; Pre-board: Yes___ No___
2nd Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm; Pre-board: Yes___ No___
CAPTAIN SAILING EXPERIENCE (Please attach additional sailing information/resume) :
Total number of years sailing experience: ________
Average number of days sailed per year/sailing season: __________
Last Charter:
Company Name:______________________________________________________________
Date _________________________ Location______________________________________
Boat Make:______________________________ Year______________ Size:_____________
Sailboats you have sailed/chartered/owned during the last 3 years:
Make of Vessel; Length; Areas Sailed; Captain/Crew; Owned/Chartered; Name of Charter Company
(1) _____________/ ______ /____________/ ___________/ ______________ / __________________
(2) _____________/ ______ /____________/ ___________/ ______________ /__________________
(3) _____________/ ______ /____________/ ___________/ ______________ /__________________
(4) _____________/ ______ /____________/ ___________/ ______________ /__________________
Sailing/Boating Courses Taken:
Name of Course; Location (City/State); Date/Year Attended
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________
Sailing/Yacht Club Memberships:
Name of Club/Organization; Location (City/State); Membership Dates
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________
References (Sailing Proficiency):
(Please Print)
Name: ______________________________________ Name:_____________________________________
Address:____________________________________ Address:___________________________________
___________________________________________ __________________________________________
City:___________________ State:____ Zip: _______ City:___________________ State:____ Zip: _______
Home #: _______________Work #________________ Home #: _______________Work #________________
Have you been involved in a boating/sailing accident(s) during the last 3 years? Yes______ No_______
If “Yes”, please attach a brief written description and explanation of the accident including the extent of the damage
(cost estimate) to the vessels involved, where, when, and how the accident occurred as well as the weather
conditions and circumstances surrounding the accident.
EMERGENCY CONTACT (Friend/Family Member to contact in case of an Emergency)
Name:____________________________________________ Relationship: ______________________
Address: _________________________________________ Phone Numbers: (w/Area Codes)
_________________________________________________ Home:____________________________
City:______________________________________________ Cell:______________________________
State:__________ Zip:_______________________________ Work:____________________________
Email Address:_______________________________________________________________________
CREW MEMBERS IN CHARTER PARTY (In addition to the Charter Captain)
First Mate (Please attach First Mate's sailing resume.)
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
CHARTER DEPOSIT/FEE/PAYMENT
I have enclosed a deposit of $500.00 with this Application to be applied toward the total Charter fee of
$____________. The balance of $____________, along with a separate refundable security deposit of $1,500 will
be paid to Annapolis Charters 30 days prior to the Charter start date and the delivery of Smooth Jazz.
Checks should be made payable to Ralph Johnson.
I understand that in the event of cancellation of the Charter by the Charterer 7 days or less prior to the Charter start
date, the entire Charter deposit shall be retained by Annapolis Charters, and that if cancellation of the Charter by
the Charterer is more than 7 days before the Charter start date, Annapolis Charters shall refund one half of the
Charter deposit to the Charterer.
I also understand that if the instant Application for Charter is not accepted by Annapolis Charters for any reason,
the Charter deposit submitted with the Application shall be returned to the Charter Applicant within 10 business days
of such notification.
I acknowledge that the information contained in this Application may be used for insurance purposes.
The information provided in this Application is true and correct to the best of my knowledge and belief.
Signature________________________________________________ Date_______________________
Please Print Name________________________________________
Mail this completed Application for Charter along with your Charter deposit to:
Annapolis Charters
Attn: Ralph Johnson
416 James Court
Falls Church, VA 22046
Thank you for your interest in Annapolis Charters and chartering Smooth Jazz!
You will be notified by email/phone regarding the acceptance of your Application.
Call Ralph Johnson at 571-276-3568 or Email him at rajohnson10@cs.com if you have additional questions
regarding this Application for Charter and/or chartering Smooth Jazz.
Application for Charter
(Please Type or Print)
CAPTAIN INFORMATION Date: ___________________
Name (Captain): ______________________________________________
Home Address: _______________________________________________
City, State, Zip Code: __________________________________________
Phone Numbers (w/Area Code)
Home: ____________________ Work: ____________________
Cell: _____________________ Other:_____________________
E-mail: ______________________________________________________
CHARTER DATE(S) REQUESTED:
1st Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm; Pre-board: Yes___ No___
2nd Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm; Pre-board: Yes___ No___
CAPTAIN SAILING EXPERIENCE (Please attach additional sailing information/resume) :
Total number of years sailing experience: ________
Average number of days sailed per year/sailing season: __________
Last Charter:
Company Name:______________________________________________________________
Date _________________________ Location______________________________________
Boat Make:______________________________ Year______________ Size:_____________
Sailboats you have sailed/chartered/owned during the last 3 years:
Make of Vessel; Length; Areas Sailed; Captain/Crew; Owned/Chartered; Name of Charter Company
(1) _____________/ ______ /____________/ ___________/ ______________ / __________________
(2) _____________/ ______ /____________/ ___________/ ______________ /__________________
(3) _____________/ ______ /____________/ ___________/ ______________ /__________________
(4) _____________/ ______ /____________/ ___________/ ______________ /__________________
Sailing/Boating Courses Taken:
Name of Course; Location (City/State); Date/Year Attended
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________
Sailing/Yacht Club Memberships:
Name of Club/Organization; Location (City/State); Membership Dates
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________
References (Sailing Proficiency):
(Please Print)
Name: ______________________________________ Name:_____________________________________
Address:____________________________________ Address:___________________________________
___________________________________________ __________________________________________
City:___________________ State:____ Zip: _______ City:___________________ State:____ Zip: _______
Home #: _______________Work #________________ Home #: _______________Work #________________
Have you been involved in a boating/sailing accident(s) during the last 3 years? Yes______ No_______
If “Yes”, please attach a brief written description and explanation of the accident including the extent of the damage
(cost estimate) to the vessels involved, where, when, and how the accident occurred as well as the weather
conditions and circumstances surrounding the accident.
EMERGENCY CONTACT (Friend/Family Member to contact in case of an Emergency)
Name:____________________________________________ Relationship: ______________________
Address: _________________________________________ Phone Numbers: (w/Area Codes)
_________________________________________________ Home:____________________________
City:______________________________________________ Cell:______________________________
State:__________ Zip:_______________________________ Work:____________________________
Email Address:_______________________________________________________________________
CREW MEMBERS IN CHARTER PARTY (In addition to the Charter Captain)
First Mate (Please attach First Mate's sailing resume.)
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
Name:______________________________________ Name:______________________________________
Address:____________________________________ Address:____________________________________
City:__________________State:______Zip:_______ City:__________________State:______Zip:_______
Home Phone:________________________________ Home Phone:________________________________
Boating/Sailing Experience: Yes___ No___ Boating/Sailing Experience: Yes___ No___
CHARTER DEPOSIT/FEE/PAYMENT
I have enclosed a deposit of $500.00 with this Application to be applied toward the total Charter fee of
$____________. The balance of $____________, along with a separate refundable security deposit of $1,500 will
be paid to Annapolis Charters 30 days prior to the Charter start date and the delivery of Smooth Jazz.
Checks should be made payable to Ralph Johnson.
I understand that in the event of cancellation of the Charter by the Charterer 7 days or less prior to the Charter start
date, the entire Charter deposit shall be retained by Annapolis Charters, and that if cancellation of the Charter by
the Charterer is more than 7 days before the Charter start date, Annapolis Charters shall refund one half of the
Charter deposit to the Charterer.
I also understand that if the instant Application for Charter is not accepted by Annapolis Charters for any reason,
the Charter deposit submitted with the Application shall be returned to the Charter Applicant within 10 business days
of such notification.
I acknowledge that the information contained in this Application may be used for insurance purposes.
The information provided in this Application is true and correct to the best of my knowledge and belief.
Signature________________________________________________ Date_______________________
Please Print Name________________________________________
Mail this completed Application for Charter along with your Charter deposit to:
Annapolis Charters
Attn: Ralph Johnson
416 James Court
Falls Church, VA 22046
Thank you for your interest in Annapolis Charters and chartering Smooth Jazz!
You will be notified by email/phone regarding the acceptance of your Application.
Call Ralph Johnson at 571-276-3568 or Email him at rajohnson10@cs.com if you have additional questions
regarding this Application for Charter and/or chartering Smooth Jazz.
| Application for Charter |
 |
 |
 |
 |
 |
 |
 |
 |
| Please Print this Application and complete by hand. Thank you! |