Town of Provincetown, MA
 
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Instructions

Please submit this form using any of the contact methods provided below.

Instructions
Provider Name
Town of Provincetown
Provider Mailing Address
260 Commercial Street

Provincetown, MA 02657
Provider Phone
(508) 487-7030
Provider FAX
Provider Email
PWhinn@provincetown-ma.gov

Application

Reference Number
QBKRRRHD
Application Status
Unknown
Application Phase
Other Public Access
Application Type
Mooring Permit
Application Subtype

Applicant

Mobile Phone
First Name
Middle Name
Last Name
Contact Information
Local Street Name
Local City
Local State
Local Zip Code
Use Same Address Below
Preferred Mailing Street Number
Preferred Mailing Street Name
Preferred Mailing City
Preferred Mailing State
Preferred Mailing Zip Code
Primary Phone
Email Address
Emergency Contact
Emergency Contact Name
Emergency Contact Home Phone
Additional Information
Are You A Provincetown Resident Or Voter?
Please circle one of the following:

Non-Resident

Resident
Senior (65+)?
Please circle one of the following:

No

Yes

Vessel

Primary Use Of Vessel
Please circle one of the following:

Commercial

Pleasure
Vessel Type
Please circle one of the following:

Commercial

Dinghy

Float

Houseboat

Kayak

Power

Sail
Size
Length
  feet     inches
Draft
  feet     inches

Wait List

Wait List Selection
Priority
List Name
Behind the Breakwater
East End
West End

Attachments

Acceptance

Terms and Conditions
BY SIGNING ABOVE, THE PERMIT HOLDER ACKNOWLEDGES THAT ALL INFORMATION IN THE APPLICATION IS CORRECT.

I have read and understand the Online Mooring User Terms and Conditions
Signature
Date
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