Yachting Client Onboarding Form

Please complete the form below to submit a new yachting client onboarding request. Note that this form should be completed for each vessel that needs to be setup.

*Fields with an asterisk are required.

Yacht / Vessel Name

What is the name of the yacht / vessel?

Vessel Captain or Manager's full name? (24/7 Client Contact Name)

First

Last

This is the person that we would reach out to if there were any concerns 24/7.

Maximum number of people onboard?

Please indicate how many people will be onboard this vessel.

Address of Business/Client

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is your head office address?

Primary Contact Phone Number (24/7 Phone Number)

This is the primary contact phone number that we would reach out to in the event there was an urgent contact issue. This could be a satellite phone number.

Main contact EMAIL address.

This would be the email that we would use to reach out to them if we have any non-urgent questions.

Client mobile/cellular Phone number? (optional)

You may optionally also provide a cell phone/mobile number.

For a call in phone number (for Telemed services), what Region do they prefer to call?

UK / International
USA
Canada

We can setup a UK number for the client for example

Service provider for the satellite phone that will be used onboard this vessel?

Start Date of Coverage

Indicate when the required coverage is to Start.

End Date of Coverage

Indicate when the required coverage is to End.

Upload an Excel, Word or PDF copy of the Medical Kit onboard the vessel. (Optional but preferred)

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Upload a Photo of the vessel (Optional, but preferred)

Drag & Drop Files, Choose Files to Upload

If possible, please upload a photo of the vessel! Supported formats are: .jpg, .jpeg, .gif, .bmp, .png

Are there any extra notes/details that you'd like to tell us? (Optional)

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View a copy of our Terms on our website here: https://praxes.ca/terms

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