Florida Commercial Saltwater Wholesale Dealer License Application Home » Florida » Commercial Saltwater » Wholesale and Retail Dealers License Application » Commercial Saltwater Wholesale Dealer License Application A brief description of the form or Application to be filled out here. Renewal Yes No License Number WD- Name First Last SSN Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCellEmail Drivers License Number Date of Birth MM slash DD slash YYYY Gender Male Female Are you a Florida Resident? Yes No Ethnicity White Black Hispanic Asian Other Business InformationOnly complete this section if applying as a corporationBusiness Name and/or Fictitious Name(As filed with the Florida Department of State, Division of Corporations) Federal Employer Identification Number Division of Corporations Document # Fictitious Name Registration # License TypeCounty Wholesale Dealer's License County Resident County Non-Resident County Alien Statewide Wholesale Dealer's License Statewide Resident Statewide Non-Resident Statewide Alien Business Address(physical location)Address Street Address County City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneAdditional Location Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Affidavit Section(This Section Must Be Completed)Full Legal Name First Middle Last Suffix Social Security Number Date of Birth MM slash DD slash YYYY Place of Birth List any citations you have received during the past three-year period (if new applicant) or previous license year (if renewal dealer), either from the Division of Law Enforcement or any other law enforcement agency (excluding traffic offenses).Date of CitationChargeCourt Disposition Is the licensee (or facility) in compliance with HACCP requirements? Yes No Contact InformationName First Last Email* Enter Email Confirm Email Phone*County Resident Application Fee Price: County Non Resident Application Fee Price: County Alien Application Fee Price: Statewide Resident Application Fee Price: Statewide Non Resident Application Fee Price: Statewide Alien 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 Consent*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. I agreeNAME:*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 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. I agreeCredit Card Having Trouble with your card?Check this box to move forward without your Credit Card. 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