Federal Permit Application for an Annual Dealer Permit A brief description of the form or Application to be filled out here. FILLABLE_CLASS Add name of CLASS under Advanced -> Default Value. Ex: Fillable_Alaska_12_10Contact InformationVessel Use / Endorsement * Required Pleasure Commercial Name First Last Email * Required Enter Email Confirm Email Phone * RequiredDealer Information (Permit Holder)Dealer's Name Do you use a DBA name? Yes No If yes, what is the DBA name? Area Code Phone Number Email If the dealer is a BusinessIf the dealer is a Business S Corporation C Corporation Cooperative Limited Liability Co. Partnership Was this Business properly established by the laws of the United States or any state of the United States? Yes No Tax ID Number (FEIN) Date Business Formed (MM/DD/YYYY) MM slash DD slash YYYY If the dealer is an IndividualIs this individual a United States Citizen or permanent resident alien? Yes No What this individual’s Sex? Yes No What is this individual’s race? White Black or African American American Indian or Alaska Native Asian American Native Hawaiian or Other Pacific Islander Name First Middle Last Suffix Tax ID Number (SSN) Date of Birth (MM/DD/YYYY) MM slash DD slash YYYY 1.b. REQUIRED—Address Information for either Business Or Individual Dealer:Mailing Address Apt # City State Zip Code Country Is the physical address the same as the mailing address? Yes No Physical Address (PO Box not acceptable) Apt # City State Zip Code Country PermitsGulf of Mexico and South Atlantic Dealer (GSAD) New Renew Domestic Atlantic Swordfish (SD) (Includes the Gulf of Mexico and the U.S. Caribbean) New Renew Atlantic Shark (SK) (Includes the Gulf of Mexico and U.S. Caribbean) New Renew Receiving FacilitiesList the names and physical addresses for facilities where product is received (fish is off loaded from the fishing vessels). Please copy this page as needed to provide information on all facilities where fish are received. If you receive product in different states, you must provide a copy of your valid State Wholesale License for each state.Is the location from where you receive product from fishermen the same as the physical address listed above? Yes No If yes, you can skip re-listing the address below.AddressFacility NameArea CodePhone NumberPhysical Address (PO Box not acceptable)Apt #CityStateCounty/ParishZip CodeCountry Businesses that Own the DealerSection 4a: Primary or Sole Owner: Complete this section if there is one or more businesses shown on the USCG Documentation, State Registration or Title as the registered owner of the vessel.Type of business S Corporation C Corporation Cooperative Limited Liability Co. Partnership Other Describe Was this Business properly established by the laws of the United States or any state of the United States? Yes No Is this the mailing recipientAll mail about this permit will go to this business Yes No Registered Name of Business Tax ID Number (FEIN) Date Business Formed (MM/DD/YYYY) MM slash DD slash YYYY Area Code Phone Number Mailing Address Apt # City State County/Parish Zip Code Country Is the Physical Address the same as the mailing address? Yes No Physical Address (PO Box not acceptable) Apt# City State County/Parish Zip Code Country Would you like to receive digital updates (texts & emails)? Yes No Email Cell Phone number and provider Section 5b: Joint Owner: Complete this section if there is another business shown on the USCG Documentation, State Registration or Title as the registered joint owner of the vessel.Section 4b Additional Business ownerConfiguration RequiredUse the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.Business Officers and Individual OwnersComplete this section by providing information on all individual officers and owners that own 1% or more of any business listed in section 1 (the dealer) and/or section 4 (businesses that own the dealer). Copy this section as needed to provide information about ALL officers and shareholders.Section 5a: Individual Officer/Owner: Business for which this individual is an officer/owner of: Position Held - Check all that Apply Percent of Business Owned: Is this individual a United States citizen or permanent resident What is this individual's Sex? What is this individual's race? Tax ID Number (SSN) Date of Birth (MM/DD/YYYY) Area Code Phone Number Mailing Address Apt # City State County/Parish Zip Code Country Is your Physical Address the same as your mailing address? Physical Address (PO Box not acceptable) Apt # City State County/Parish Zip Code Country Would you like to receive digital updates (texts & emails). Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Section 5b: Minor Shareholders: Complete this section by providing information on all individual officers and owners that own less than 1% of any business listed in section 1 (the dealer) and/or section 4 (businesses that own the dealer).Do one or more owners (individual or business) hold shares that are less than 1% of the total business shares? Yes No What is the total percentage of business shares held by minor owners? Small Business or Organization CertificationIs the business primarily involved in harvesting seafood (commercial fishing)? Yes No 1A) Was the business active prior to this year? Yes No 1B) What was the most recent year the business was active prior to this year? 1B) Did the business have more than $11 million in gross receipts in that year? Yes No Is the business primarily involved in for-hire fishing services (charter, party/ headboat)? Yes No 2A) Was the business active prior to this year? Yes No 2B) What was the most recent year the business was active prior to this year? 2B) Did the business have more than $7.5 million in gross receipts in that year? Yes No Is the business primarily involved in buying and selling seafood (seafood dealer/wholesaler)? Yes No 3A) Was the business active prior to this year? Yes No 3B) What was the most recent year the business was active prior to this year? 3B) Did the business have more than 100 employees? Yes No Is the business primarily involved in processing seafood (seafood processor)? Yes No 4A) Was the business active prior to this year? Yes No 4B) What was the most recent year the business was active prior to this year? Yes No 4B Did the business have more than 750 employees? Yes No Is the organization an Environmental, Conservation and Wildlife, or Professional Non-Profit Organization? Yes No 5A) Was the organization active prior to this year? Yes No 5B) What was the most recent year the organization was active prior to this year? 5B) Did the organization have more than $15 Million in gross receipts? Yes No Is the organization some other Non-Profit Organization (e.g., business association)? Yes No 6A) Was the organization active prior to this year? Yes No 6B) What was the most recent year the business was active prior to this year? 6B) Did the organization have more than $7.5 Million in gross receipts? Yes No The business or organization must be primarily involved in another industry not related to fishing or seafood. Refer to SBA’s list of NAICS codes (see https://go.usa.gov/xRGvQ) and enter the NAICS code for your primary activity here: Based on the applicable SBA size standard, check the appropriate box to indicate if the business or organization is Large or Small and report the year on which that conclusion was based. Large Small Year Application Fee Price: RENEWAL ADVANCED PAYMENT OPTION No Additional Years 2 year renewal 3 year renewal 4 year renewal 5 year renewal Total $0.00 SignatureConsent * Required I agreeI CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.Applicant Signature * RequiredNAME: * Required Type your full name to sign this secure webformPosition in Company (if applicable) Date MM slash DD slash YYYY Authorization * Required I agreeI agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected permits. I understand that my application will be processed in the order in which it is received by Commercial Fishing Permits Center, a private fee-for-service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Commercial Fishing Permits Center's no refund policy. I understand that submitting another application for a license or permit will supersede the current/pending application for that license or permit. I understand that Commercial Fishing Permits Center does not issue or sell any licenses or permits.Credit Card Having Trouble with your card? 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