Food Fish and Crustacea Dealers & Shippers - Commercial Fishing Permits Center

Vessel Name

Vessel Use / Endorsement

Pleasure
Commercial

Official Number

Confirm Official Number

Corpration?

Yes
No

For corporate applicants, are you a corporation in good standing?

Yes
No

NYS Domicile?

Yes
No

Applicant Name

First Last

Mailing Address

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

Home Address (if different)

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

Other Address for Business or Facility Location

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

Country Issuing Taxpayer ID

Taxpayer ID/SSN

Township

County

Home Phone

Business Phone

Fax Phone

E-Mail

Physical Description

Date

Gender

Male
Female

Hair Color

Eye Color

Height

Weight

Federal Permit Number?

Yes
No

Company Name

Federal Permit Number

Authorized Representative Contact Information

Business Phone

Home Phone

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Corporate Officer Contact Information

Business Phone

Home Phone

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Partner Contact Information

Business Phone

Home Phone

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Sole Owner Contact Information

Business Phone

Home Phone

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

FF&C Dealer/Shipper License No:

Name/Corporation Name on License:

Address

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

Phone

Please indicate your license or permit status by checking the appropriate box below:

I hold a FEDERAL seafood dealer permit from National Marine FIsheries Service
I ONLY hold a NYS Dealer license. I purchase seafood directly from harvesters in NYS. I do not hold a federal seafood dealer permit.
I ONLY hold a NYS Dealer license. I make no purchases directly from harvesters in NYS.

Federal Dealer Permit #

Email

Address

Street Address Address Line 2 City State ZIP Code

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 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

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.

Credit Card

Card Details

Cardholder Name

Having Trouble with your card?

My card information is not working

Check this box to move forward without your Credit Card.

BILLING ADDRESS

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

By clicking submit you agree to these Terms and Conditions and the above authorization of payment.