Wholesale Bait License Application - Commercial Fishing Permits Center

Vessel Name

Vessel Use / Endorsement*

Pleasure
Commercial

Official Number*

Confirm Official Number*

First Time Application
Application for Renewal
Reporting Dealer
Non-Reporting Dealer

Dealer Number

SSN / Tax ID

Business Name

Oregon Business (Licensed) Location

Street Address Address Line 2 City State ZIP Code

Business Phone Number

Fax Number

Email

Plant Manager

Bookkeeper

Mailing Name

Mailing Address

Street Address Address Line 2 City State ZIP Code

If your plant is not open year round, where may we contact you?

Street Address Address Line 2 City State ZIP Code

Phone Number

Date of Birth

Driver's License State

Driver's License Number

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Application Fee

Price:

1st Year Bond

Price:

Agent 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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Check this box to move forward without your Credit Card.

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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.