Application for agency services

Customer Data:

Organization:

Contact:

telephone Customer:

(telephone number with area code / mobile phone)

Ship Information:

Name of vessel:

Owner:

Flag:

Ship Type:

dimensions of the vessel:

(According to international
measurement certificate)

Length (LBP):

Width (B):

Depth (DM):

Max draft (T):

Information vessel call:

Port of call:

last port of call (from):

next port of call (where):

Cargo type:

Amount of cargo:

operations (loading / unloading):

needed services: