Is this your first charter with us?______
Have you rented a sail/power boat before?__________
Name:_________________________________________ Date:__________
Address:____________________________________________________________
City:________________________State:_____________Zip:____________________
Phone: Work ( )___________________________
Home ( )___________________________
Driver's License Number:________________________State:___________________
Chesapeake Sailing School Graduate: Yes o No o
Highest level achieved___________________ Year_______
ASA Level________________________US Sailing Level_______________________
Auxiliary Powered Sailing Experience:_____________________ Years____________
SKIPPER/BAREBOAT SAILING EXPERIENCE:
(list relevant/similar experience to charter request)
Make/Size Chartered From City/State Date/Year
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Largest Boat Owned: Make/size:____________________ Sail o Power o
# Years______________________
Instruction Other than CSS:______________________________________________
Most recent course taken:_______________________________________________
Place of Instruction:____________________________________________________

Due to the provision of the CSS Charter Fleet insurance policy, the information below
is required from each customer chartering a yacht. Please fill in each blank completely.
Name/Address of Current Employer:
___________________________________________________________________
___________________________________________________________________
Employed since (month/year):____________________
Name/Address of Previous Employer (if above is less than 3 years)
___________________________________________________________________
___________________________________________________________________
Birth Date:_______________________Social Security #:______________________
Name of your Bank:___________________________________________________

Signed ____________________________________________________ Date ___________