ResqVester Retail Registration Form

Purchase- Store Name:

Purchase- Store Location:

BoatSafe Tag Number:

Type of Registration: (Click for Help)

Vessel
Personal

Name of Vessel:

Vessel State Registration Number:

Vessel Dock Location:

Enter your primary email address below:
Enter Email Address:

Enter Email Address Again:
(mandatory) (Example: name@domain.com )

Please complete the following section:
The address you want us to send process service documents to:

Name:
Street Address:
Apt. No./Other:
City:
State:
Country:
ZIP Code/Postal Code
Home Phone:
Ideally this is a phone with voice mail that you would check.

Cell Phone:
If you have a cell phone, enter the number here.

Enter a Password you will remember. Thank you.
Maximum length 10 characters. We recommend an easy to remember password. Letters should be ONLY in lower case.

Pick a Password:

Enter the Password Again:

For Vessel Registrations Please Enter a Description of Your Vessel/Boat/Ship:

What are the maximum number of passengers/crew your vessel is licensed for?
Maximum Passengers:

For Personal Registration Please Provide Critical Medical Information that
Would be Useful to the Coast Guard and other First Responders.