Galaxsea Yachts Inc.

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Request Form
Please complete the form below in order for us to email you further information on links to yachts as well as their appropriate rates and details. All information supplied is free.

Contact Information

Name:		Company:
Street:		City:
State:		Zip:
Country:
Daytime Phone:		Evening Phone:
Email:		Fax:

Yacht Information

Have you chartered before?	Yes No
If yes, yacht type?	Power Sail
Where would you like to charter?
How long would you like to charter?	Days
When would you like to start your charter?:
How many guests are in your group?	Guests
What size yacht would you like to charter?:	Feet
What type of yacht would you like to charter?	Power Sail Catamaran
What is your budget per person per day?:
Any additional information you would like us to consider in choosing your perfect yacht and crew:

757 SE 17th Street #714 | Ft. Lauderdale, FL 33316
Ph: 954-462-6949 | Fax: 954-462-6841
Email: info@galaxseayachts.com