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Application Form
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Application Completion
Instructions
Please submit this form using any of the contact methods provided below.
Instructions
Provider Name
Online Mooring, LLC
Provider Mailing Address
Brad Hurley, COO
76 Pratt St
Glastonbury, T 06033
Provider Phone
813-666-7464
Provider Email
bhurley@onlinemooring.com
Application
Reference Number
YHZYTPGV
Application Status
Unknown
Application Phase
Other Public Access
Application Type
Mooring Permit
Application Subtype
Application Comments
Applicant
First Name
Middle Name
Last Name
Suffix
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Local Street Name
Local City
Local State
Local Zip Code
Home Phone (Summer)
Home Phone (Winter)
Mobile Phone
Work Phone
Email Address
Additional Information
Resident?
Vessel
Registration State
Reg or Doc #
Vessel Name
Hull ID
Vessel Type
Size
Length
feet
inches
Beam
feet
inches
Draft
feet
inches
Characteristics
Vessel Make
Vessel Color
Accessories
MSD
Other
Vessel Photo(s)
(Maximum file size=10MB)
Vessel Comments
Berth
Inspection
Seasonal Status
Location
Application Latitude/Longitude
Latitude
Degrees
Minutes
Seconds
Longitude
Degrees
Minutes
Seconds
Other
Access Point
Attachments
Attach a paper copy of each attachment listed below:
Boat Registration
Expiration Date
Proof of Insurance
*
Expiration Date
Acceptance
Terms and Conditions
30%">
I agree to abide by decisions of the Harbor Master and the Coastal Waters Ordinance.
I have read and understand the Online Mooring
User Terms and Conditions
Signature
Date
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