EmailMe Form - EPIRB Hire Form

Name of Vessel *

Vessel Type *

Enter the make model or use of vessel. For Example: Bavaria 34 or Work Boat

Intended Sailing Area *

Activity *

Coding Category

Add Flares to Hire Agreement *

No

RORC Pack

Offshore Pack

Coastal Pack

Commencement Date *

DD / MM / YYYY

This is the date you wish the Hire to commence

Hire Term *

How long you wish to hire the liferaft

Customer Name *

First Last

Company Name

Customer Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Delivery/Collection Options *

I will Collect/Deliver at Suffolk Marine Safety Ipswich

I will Collect/Deliver at a Suffolk Marine Safety Collection Point

I would like Delivery/Collection at my Marina or Home address

Delivery/Collection Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number *

Email *

Confirm

Have you bought or hired from Suffolk Marine Safety before?

Yes

No

Comments and Special Requirements