Merle Wood & Associates, Inc. - Request Materials -

PLEASE ENTER YOUR CONTACT INFORMATION ---------------------

First Name*

Last Name*

Title

Email*

Home Phone

Work Phone

Cell Phone

Fax

Company

Street Address

City

State/Province

Zip/Postal Code

Country*

Best Time to Contact

* REQUIRED FIELDS

HOW DID YOU HEAR ABOUT US ----------------------------------------

Interests -----------------------------------------------------------------

Similar to (yacht name)

CHARTER -------------------------------------------------------------------

# of Guests

Preferred Dates

Cruising Area

Is this your first charter?

BROKERAGE OR NEW BUILD --------------------------------------------

Length Desired

# of Staterooms

Preferred Builder

Is this your first purchase?

MATERIALS REQUESTed: ------------------------------------------------

YOUR COMMENTS HERE: -------------------------------------------------

PH: 954-525-5111 • 888 EAST LAS OLAS BLVD, 4TH FLOOR, FORT LAUDERDALE, FL 33301 • FAX: 954-525-5165