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CHECK/MONEY ORDER PAYMENT

Gold Listing Prices:

1 Year = $60.00

2 Years (Special #1) = $90.00

3 Years = $130.00

2 Gold Listings for 2 Marinas = $90.00

INSTRUCTIONS FOR SENDING PAYMENT:

1. You will receive an email invoice from MarinaMate.com after you fill out and send the form below. Print the email invoice out and include it with your remittance.

2. Make check out to Harrison Electronic Systems, Inc. (MarinaMate.com's parent company)

3.. Send check or money order to:
MarinaMate.com
c/o Harrison Electronic Systems, Inc.
1167 N. Washington St.
Wilkes-Barre, PA  18705
USA

4. You will receive an email confirmation when your payment is received. Your Gold Listing will be posted within 4-6 days of receipt of payment.

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GOLD LISTING FORM:
*Required Fields

Please fill in the boxes below, then click SEND.

Type of Listing:
1-Year Gold Listing ($60.00)
2-Year Gold Listing ($90.00)
3-Year Gold Listing ($130.00
2 Gold Listings for 2 Marinas ($90.00) Please fill in this form and send it twice, once for each marina.

*E-mail address:

Marina Information:

*Contact Name:
*Marina Name:
Marina Email:
Website URL:
*Address1:
Address2:
*City:
*State:
*Zip:
*Country:
*Telephone1:
Telephone2(or Toll Free):
Fax:
If your Marina is on a lake, river harbor, etc. please list it here:

Check all that apply:

120 Volt Service	220 Volt Service	3 Phase Service
Water Hookup	Pump-out Service	Phone at Slip
Cable TV at Slip	Security	Travel Lift
Fuel Dock	Transient Slips	Service & Repairs
Dry Dock	Storage	Covered Slips
Boat Ramp	Pool	Ship's Store
Hotel	Restaurant	Laundry
Restrooms	Showers	Block Ice
Bag Ice	Groceries	Bait & Tackle
US Mail

Marina Info:

Number of Slips:
Max. Dock Length (in feet):
Monitored VHF Channel:
Hours of Operation: (indicate weekdays & weekends)

Location:

Latitude:
Longitude:
Intracoastal Waterway Marker #: (if applicable)

Marina Description (no more than 150 words):

Specials:

Discount Code:
- If you have received a code for a "Specials" discount, please enter it here.

SPECIALS - Check the box(es) below if you wish to receive any of the specials.

1-Year Banner Ad - FREE with a 1 Year Gold Listing

After submitting this form: 

• To complete your Gold Listing, please go to our GOLD LISTING LOGO page for information on how to send your marina's logo.
  

• Your GOLD LISTING will be posted online within 4-6 days after receipt of payment and logo.
  
• Direct all questions to GOLD LISTING INFO.

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A division of Harrison Electronic Systems, Inc.
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