Name of Vessel:                            Owner:       

Location of Vessel:                        Address:   

Year of Mfr:                                   Email:       

Colour of Vessel:                           Fax:           

Make & Model:                            Phone:       

Size of Vessel:                               Anti-fouling Protection

                                                                                                    required?

                                                                                                                        YES   NO

                                                                              Is the Vessel?

                                                In water?     In storage?   In dry dock?

                                    State of Hull & Superstructure?                                             Further comments?

                                                                 Vessel Availability for treatment?                              

                                                        until

                                                                I am also interested in Protection for my?

                                                                    Aircraft      Car      Other

Have a member of your team contact me

sales@permagard.info

                                                         Permagard UK Limited standard trading terms and conditions apply.

                                                                                                The information contained in this enquiry will be treated

                                                                                                                    Strictly private & confidential;

                                                                                    For the express purpose of supplying Permagard service indication of terms.

                                                                       Permagard will require the vessel to be available for inspection prior to release of indicated terms.

Permagard UK Limited                                                                                                                                            

Unit 1v, Standard Industrial Estate, Factory Road, London. E16 2EJ

T: 0207 473 0099 / F: 0207 474 0771 / W: www.permagard.info                                           

                                                                                                                                              © Permagard (UK) Limited 2003-2005