Complete both sides of this form and sign.

BROKERAGE FORM

32 New York Avenue

Huntington NY 11743

call (631) 421-3366

www.coneys.com

info@coneys.com

fax (631) 549-7392

Owner’s Name:_______________________________________________________________________________

Address: _____________________________________________________________________________________

Home Phone: _________________________________ Cell Phone: ___________________________________

Boat Location: ____________________________________ Key Combo: ___________________

Boat ID Hull#: _________________________________________________________________________________

Boat Registration Number: _____________________________________________________________________

Documentation #: _________________________________________________________

Is there a loan on the boat? Yes No Estimated Loan Balance: _______________________

Name of Bank: _________________________________________________________

Bank Address: _________________________________________________________

Bank Phone: ______________________________________Account Number: _____________________

PLEASE FILL OUT BELOW

Brokerage Agreement made by and between the owner, and Coneys Marine Corp. The owner agrees that the yacht will be sold free and clear of any liens, bills or encumbrances of any nature whatsoever. The owner warrants and will defend that he has good and marketable title thereto and the lawful right to sell the same, and will deliver all necessary documents for the transfer of the title, to the broker, at the request of Coneys Marine Corp.

Owner agrees to pay Coneys Marine Corp. 10% of the sale price or $4,000.00, whichever is higher, which shall be dueupon sale of the above listed yacht to any purchaser who has been shown the subject yacht by a Coneys Representative. This agreement shall remain in effect until the yacht is sold.

Listing Price: $___________________________________________________

Owner's Signature:__________________________________________ Date: ____________

List additional gear: Cradle Trailer Winter Cover

Additional (if not on other side) _____________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Wheel Brake

Pedestal Guard Tiller

Hiking/Tiller Extension

STEERING SYSTEM Engine Hours: _____

Make: ______ Model: ______ HP: ___

Fresh Water Cooled Diesel Gas

Inboard Outboard

Gen/Set Make: ____________

ENGINE

List brand and year if known Depth __________ Knot __________

VHF Radio __________ Compass __________ Stereo _______________ Wind Speed ______________

Wind Direction ___________________ Auto-Pilot ____________ MFD _____________ Radar ___________

AIS ________________ Additional: _______________________________________________________________

ELECTRONIC EQUIPMENT

Layout Type Dinette [] Traditional [] Headroom ____ft. _____in. Aft Cabin

Quarter Berth Pilot Berth Sleeps _____ # of Heads____ manual marine portable electric

Y Valve for Head Head forward aft Holding Tank Holding Tank Pumpout # of Head Sinks ____

# of Galley Sinks ____ Stove # of Burners ______ Oven propane Alcohol CNG Ice Box Refrigerator

Portable Ice Cooler Water System cold hot manual pressure Head Shower Cockpit Shower

Chart Table Transom Swim Platform Additional _______________________________________________

ACCOMODATIONS

Complete both sides of this form and sign.

Please list the year of any updates and the brand if applicable.

BROKERAGE FORM

32 New York Avenue Huntington NY 11743

call (631) 421-3366

www.coneys.com

info@coneys.com fax (631) 549-7392

Manufacturer: ______________________ Model: ______________________ Year:_______

Boat Name: ___________________ Hull Color: __________________ Deck Colors:___________________

Keel Type: Wing Shoal Fin Full Centerboard

HULL

LOA: _______ft. _______in.

LWL: _______ft. _______in.

Beam: _______ft. ______in.

Draft: _______ft. _______in.

Displacement: ________lbs.

Ballast: _____________ lbs.

Sail Area: _________ sq. ft.

Designer: ______________

SPECIFICATIONS Sail Age: __________Mainsail Dutchman

Full Batten Lazy Bag Mainsail Cover

Jib Sail Storm Jib #1 Genoa Sail #2 Genoa Sail Spinnaker

Spinnaker Pole & Gear Cruising Spinnaker Sail Whisker Pole

Furling: Genoa Staysail Main / Harken Hood Stream Stay Cruise Design

# of Deck Winches ______ Lewmar Barient Barlow Size _____ Selftailing

# of Mast Winches ______ Lewmar Barient Barlow Size _____ Selftailing

Aft Lead Halyards Aft Lead Reefing Additional: ______________________

SAIL INVENTORY & GEAR

# of Batts _____ Shore Power Cord

Battery Charger Bow Thruster

Air Conditioner # of AC zones: ________

Other: _______________________

ELECTRICAL SYSTEM

Bow Rail Life lines single double Stern Rail Anchor Well

Anchor Roller Anchor Windlass Anchor & Line Davits Dock Lines Fenders Flares

Boat Hook Bilge Pump Horn Fire Extinguisher Life Jacket Backstay Adjuster Dinghy

Swim Ladder portable [] built-in [] Cockpit Table Barometer Oil Lamp Ship's Clock Cockpit Dodger

Sun Awning Bimini w/frame Carpeting Custom Fitted Cockpit Cushions Additional: _______________

_______________________________________________________________________________________________

EQUIPMENT AND RUNNING GEAR