/ Doc Date: 10.9.10page 1 of 1Client Consent Form
We are approved and operating mooring contractors for Waikato Regional Council, Auckland Regional Council, & Northland Regional Council / 700 Waiteitei Road
RD4 Wellsford 0974
Phone-027 492 6041

Dear client,

This document represents an application to Hauraki Marine Services 2016 Limited (HMS) to have your mooring inspected and if necessary serviced. It outlines the various payment terms and service optionsavailable and gathers some of the basic information about your mooring. Once the preferredservice options are selected and authorisation is signed and returned, HMS will deem this document an order to inspect your mooring against the managing authority’s recommended standards.

As the client you can select either of the following inspection and service options;

  1. Have your mooring inspected only, without a service, resulting in amooring inspection report only.
  2. Be present at the inspection of your mooring to witness the mooring service.HMS welcomes client attendance. However, you will have to make personal arrangements to be onsite when HMS notifies you of the service day.
  3. Have your mooring inspected and automatically maintained if necessary, from which a full work list will be provided with the invoice.

Payment Terms:

  1. Inspection and maintenance charges areon7 day invoice.
  2. Sent out with the invoice will be adraft inspection report. Only upon full payment of the seven day invoicewill a signed copy of the inspection report besent to the managing authority.
  3. Equipment supplied will remain the property of HMS until accounts are paid in full.

Service Details/Options:

Mooring Owner (tick one) / OR Mooring Leaseholder / Mooring Area:
Name / Council Inspection due date:
Postal Address / Contact Options / Boat Name
After Hrs
Work / Mooring No.
Mobile / Boat Weight (T)
Email / Boat Length (m)
Please indicate your preference by ticking the relevant boxes?
1. Inspect my equipment only……………………………………………………………………………………………………………………………………..
2. I want to be present when my equipment is inspected……………………………………………………………………………………………
3. Inspect and maintain if necessary without notification and provide a breakdown of work list with invoice…………….
4. I want to upgrade the size of my mooring……………………………………………………………………………………………………………….
5. Please indicate if your mooring service is currently booked with anothercontractor?......
Authorization, Client statement and Liability Disclaimer
As the client I have read, understood and agree to the above Hauraki Marine Services 2016Limited Payment Terms. By signing this document I authorize Hauraki Marine Services 2016 Limited to inspect and service my mooring as indicated by my selections above. I understand that I bear sole responsibility for my decisions and my information. I understand that HMS may rely upon the information I have supplied. I understand that while all care and responsibility will be taken by HMS, no liability or any consequential loss will attach to HMS for loss or damage.
Signed / Date

Please write any further details, comments or requests on the back of this form. If you have any questions please call us. Thankyou.

HMS execute industry highest standard practice and use quality assured, tested materials in maintaining moorings.