Document Submission

2. 
4. Date
   Date
5. Basin*
   -- Select One --EAST WEST
6. Slip Number*
8. Primary Berth Holder Name*
9. Email Address*
10. Phone Number*
14. If you are uploading your berthing license renewal and supporting documents, you may do so in one PDF or separate files.
16. Will you be uploading multiple or a single document?
    -- Select One --Single2 Documents3 Documents4 Documents5 Documents6 Documents7 Documents8 Documents
18. Document Type *
    -- Select One --Berthing License Renewal FormResidency VerificationInsurance RegistrationPhoto ID Key Form Parking Pass Form Contact Authorization FormOther
19. Document Type 2*
    -- Select One --Berthing License Renewal FormResidency VerificationInsurance RegistrationPhoto ID Key Form Parking Pass Form Contact Authorization FormOther
20. Document Type 3*
    -- Select One --Berthing License Renewal FormResidency Verification Insurance RegistrationPhoto ID Key Form Parking Pass Form Contact Authorization FormOther
21. Document Type 4*
    -- Select One --Berthing License Renewal FormInsurance RegistrationPhoto ID Key Form Parking Pass Form Contact Authorization FormOther
23. Other Document *
24. Other Document*
25. Other Document*
26. Other Document*
28. File *
29. File 2*
30. File 3 *
31. File 4*
33. Document Type 5*
    -- Select One --Berthing License Renewal FormInsuranceRegistration Photo IDKey FormParking Pass FormContact Authorization FormOther
34. Document Type 6*
    -- Select One --Berthing License Renewal FormInsuranceRegistrationPhoto IDKey FormParking Pass FormContract AuthorizationOther
35. Document Type 7*
    -- Select One --Berthing License Renewal FormInsuranceRegistrationPhoto IDKey FormParking Pass FormContact Authorization FormOther
36. Document Type 8*
    -- Select One --Berthing License Renewal FormInsuranceRegistrationPhoto IDKey FormParking Pass FormContact Authorization FormOther
38. Other Document*
39. Other Document*
40. Other Document*
41. Other Document*
43. File 5*
44. File 6*
45. File 7*
46. File 8*
48. Comments
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field