Town of Westerly, RI - Application Form

Instructions

Please complete the application, then click the "Next" button below. For help on any field, move the mouse over the field name.

Instructions

Mooring permit applications are due by March 1st.

Provider Name

Town of Westerly

Provider Mailing Address

Tax Collector's Office -
45 Broad Street
Westerly, RI 02891

Provider Phone

(401) 714-4114

Provider FAX

Provider Email

krayner@westerlypolice.org

Application

Application Status

Unknown

Applicant

Mobile Phone

First Name

Last Name

Contact Information

Mailing Street

Mailing City

Mailing State

Mailing Zip

Use Same Address Below

Local Street Number

Local Street Name

Local City

Local State

Local Zip Code

Primary Phone

Work Phone

Email Address

Emergency Contact

Emergency Contact Name

Emergency Contact Home Phone

Emergency Contact Email

Additional Information

Resident?

Vessel

Vessel Type

Size

Length

feet

inches

Wait List

Wait List Selection

Select up to 1 list(s):

List Name

Colonel Willie Cove

Haversham East

Haversham West

Point Dock at Shelter Harbor

Riparian Permit (Waterfront Property Owner)

The Groves at Shelter Harbor

Watch Hill Cove

Weekapaug Cove

Attachments

Please provide attachments below, preferably in a PDF or image format. To convert a paper document to electronic format, take a photo of the document.
If we have a current copy on file, you will see a link to it. Update the attachment if it has changed, or if requested.

Proof Of Insurance

Filename

(Maximum file size=10MB)

Expiration Date

Acceptance

Terms and Conditions

Mooring Permit Application:

I certify that the information on this application is correct and that fees must be paid by credit card or Electronic Check. Fees associated with this application are non-refundable. I further understand that I must comply with all town mooring ordinances, or this permit may be revoked. Moorings must be occupied as the primary berth for the vessel.

By checking this box and typing my name, I intend to electronically affix my signature, indicating that I have read, understand and affirm this attestation. *

Waiting List Application:

I certify that the information on this application is correct. I further understand that this is an application to be placed on a waiting list for a mooring and that this application is required to be renewed annually.

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

I have read and accept these terms