Mothership Cooperative Permit Application Form - Commercial Fishing Permits Center

A brief description of the form or Application to be filled out here.

Contact Information
Name
First Last
Email*
Enter Email Confirm Email
Phone*
Vessel Name
USCG Doc or State Registration Number*
Confirm USCG Doc or State Registration Number*
Vessel Use / Endorsement*
- Pleasure
- Commercial
Section A - Cooperative Contact Information
Name of Cooperative Entity
Cooperative TIN
State Cooperative Entity Registered In
Business Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone
Business Fax
Business Email
Name of Cooperative Manager
First Middle Last
Cooperative Manager DOB
MM slash DD slash YYYY
Section B - MS/CV Permits Obligated to Cooperative and Processor Obligation
MS/CV Permits Obligated to Cooperative and Processor Obligation
MS/CV - Endorsed Permit Number MS/CV - Endorsement and CHA ID Number Catch History Assignment (%) Obligated to MS Permit Number
Total (%) in Catch Assignment History
Section C - Catcher Vessel Information
List
Vessel Name USCG Documentation Number
Section D - Certification of Applicant
Application Fee
Price:
Total
$0.00
Consent*
I agree
I 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.
NAME:*

Type your full name to sign this secure webform
Signature*
CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)
Date
MM slash DD slash YYYY
Authorization*
I agree
I 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.
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MS/CV - Endorsed Permit Number	MS/CV - Endorsement and CHA ID Number	Catch History Assignment (%)	Obligated to MS Permit Number

Vessel Name	USCG Documentation Number

Contact Information

Section A - Cooperative Contact Information

Section B - MS/CV Permits Obligated to Cooperative and Processor Obligation

Section C - Catcher Vessel Information

Section D - Certification of Applicant