Application for a Permit to Collect Marine and Estuarine Organisms for Scientific Purposes

For use in Calendar Year

Application Type

New
Renewal

Previous Year's Permit Number

Any changes to previous year's permit?

Yes
No

Only include requested changes below.

Applicant

First Last

Address

Street Address City State ZIP Code

Work Phone

Cell Phone

Fax

Email

Scientific Institution with which associated or by whom sponsored

Address

Street Address City State ZIP Code

Telephone

Purpose of scientific investigation

Are any of the species being collected for public display?

Yes
No

Is the applicant an aquarium?

Yes
No

Is the aquarium accredited by the American Zoo and Aquarium Association (AZA)?

Yes
No

What is the final destination of the organisms collected?

If the applicant has a temporary holding facility in NJ, please provide address and telephone number:

Does the applicant have an exempted fishing permit from the National Marine Fisheries Service?

Yes
No

Provide permit number

Does the applicant intend to collect hard/soft clams, mussels, oysters or other bivalve mollusks?

Yes
No

Does the applicant intend to collect horseshoe crabs?

Yes
No

Does the applicant intend to collect diamondback terrapins?

Yes
No

Other species to be collected

Does the applicant intend to retain any organisms after field observation?

Yes
No

Please list species, amounts and reason for retention

Location(s) where collecting is proposed (Be specific)

Equipment proposed to be used in collecting (size of gear, mesh, etc.)

Time of year permit collecting will take place (Be specific)

Vessel(s) and description of vessel(s) to be used in collection

Vessel Name	Registration #	Vessel Length (in feet)

Will any other individuals be collecting under your supervision?

Yes
No

list individuals below with an explanation of their role in the proposed scientific investigation

Individuals should be project leaders or anyone responsible for field sampling. List only those responsible for leading field crews, not every student or employee involved with sampling.

Individual	Role

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

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 agree

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

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 agree

Credit Card

Card Details

Cardholder Name

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BILLING ADDRESS

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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