Membership Application

Name *

Address *

Address 2

City *

State *

Zip / Postal Code *

Phone Number *

Email Address *

Is your boat trailered or in a marina? *

What marina?

Boat name or registration number?

How would you like to pay? *

If paying by check please mail payment to: Lakeshore Towing 34 State Street Erie, Pennsylvania 16507-1474

Credit Card Number

Credit Card Expiration Date (mm/yyyy)

CVV Code

Boat Information

Boat Make *

Length *

Color

Power

Choose Your Plan

Please note: Membership will not take effect until 24 hours after payment is received. Coverage is not provided for pre-existing conditions. Boat must be in good running order at time of purchase.

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