BARTLETT MARINE SERVICES AND CONSULTING LLC

MARINE SURVEY WORK ORDER

                CUSTOMER (survey ordered by):________________________________   DATE:___________

                CUSTOMER ADDRESS:________________________________________________________

                PHONE:_______________________________        RELATION TO VESSEL:______________

                NAME OF VESSEL:____________________________________________________________

                LOCATION OF VESSEL:________________________________________________________

                BUILDER:_________________________________   MODEL:__________________________

                YEAR BUILT:_________________   HIN #:_________________________________________

                LOA:__________________   BEAM:_________________   DRAFT:_____________________

                DOCUMENTATION/REGISTRATION #:__________________________________________

                OWNER OF VESSEL (if different from above)_______________________________________

                OWNER ADDRESS:____________________________________________________________

                OWNER PHONE:______________________________________________________________

                TYPE OF SURVEY:

                    Circle one:      BUYER          INSURANCE        FINANCE       DAMAGE        SELLER

                    Circle one:      POWER          SAIL

                    Circle one:      IN THE WATER                                 OUT OF THE WATER

                    SEA TRIAL:_______________         YES                 ______  NO

                              Payment is due at time of inspection  $_______________

                I  agree to the above terms and consent to the Scope Of Survey (signature)_________________

                 * AUTHORIZATION TO BOARD THE ABOVE NAMED VESSEL

                Survey Schedule Date:_________________ (owner or agent)____________________________

                Location of Key:_____________________  Combination of lock:_________________________