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SMAST TEST TANK USAGE REQUEST

Date(s) and Time(s) of Use:

Name of Organization:

Date:

Billing Information:

Name:

Day Phone: Email:

Billing Address: Purchase Order #

City: State: Zip:

Billing Rates Category:   Check One Category: Full day   Half day
                                          Life Support: Without   With

UMass Dartmouth Users (Student / Faculty / Staff of UMass)
Internal Users - A custumer who pays for goods or services using a university account. (Safety Training, Community Awarness)
External Users (Corporate / Companies / Private)

WATER REQUIRED: Sea Water Fresh Water Not Applicable
Special Water Conditions: $4000 Water Switch Over Fee Will Apply (Allow 4 Weeks Prior)
Check Online Calendar For Current Water Condition.

SPECIAL REQUIREMENTS: Instruments, environmental, handling, preparation, etc. (list):

LIABILITY AND INSURANCE AND CONTRACT REQUIRED: On File To Be Sent
(External Groups Only)

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UMass Dartmouth • School for Marine Science and Technology • 706 Rodney French Blvd • New Bedford, MA 02744-1221
Phone: 508 999-8193 • Fax: 508 999-8197