Winter Cover Information
	Frame and Cover System    Boomtemt System Frame Only    Replacement Cover
Personal Information
First Name
Last Name
Email Address
Address Line 1
Address Line 2
City
State	--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Outside USA
Country	--Select Country-- USA Canada Other
Zip Code
Day Phone
Facsimile
Shipping Information
	Same as above (Skip to Boat Information)
Address Line 1
Address Line 2
City
State	--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Outside USA
Country	--Select Country-- USA Canada Other
Zip Code
Boat Information
Boat Name
Manufacturer
Model
Length (in feet)
Year
Winter Storage Information
Boat Yard Name
Address Line 1
Address Line 2
City
State	--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Outside USA
Country	--Select Country-- USA Canada Other
Zip Code
How will your boat be stored in the winter?
Will the boat be in the water? Yes No Will the mast be in the boat? Yes No
Does your boat have aftermarket hardware?
Does the boat have a Radar Mast? Yes No Does the boat have Davits? Yes No
Please specify any additonal hardware here:
Additional Information/Special Circumstances
Extra Credit
How did you hear about us?	Northern Breeze    Windcheck Northeast Sailing    Soundings Sailing    Boat Show Friend    Internet Saw Cover in Yard    Other Sail Magazine
If other, please specify
Reply Information
Contact you by: Email Phone Fax

FAIRCLOUGH SAILMAKERS INC.est.1938
620 ELLA GRASSO BLVD.
NEW HAVEN CT, 06519
phone:1-(203)787-2322 fax:1(203)787-2334