Coast Guard Vessel Documentation Change of Address

VESSEL NAME

OFFICIAL NUMBER*

CONFIRM OFFICIAL NUMBER*

NEW PHYSICAL ADDRESS?*

New Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Old Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

NEW MAILING ADDRESS?*

New Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Old Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

CONTACT INFORMATION

Name

First Last

Email*

Enter Email Confirm Email

Phone*

(###) ###-####

APPLICATION FOR CHANGE OF ADDRESS

Price:

Please select any additional services you wish to have processed

Priority Request/Rush Processing*

Price:

Total

$0.00

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 CERTIFY THAT THIS REQUEST HAS BEEN MADE WITHIN 10 DAYS OF THE ADDRESS CHANGE.

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NAME:*

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 USCG documents. I understand that my application will be processed in the order in which it is received by Vessel Documentation Online LLC, 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 Vessel Documentation Online LLC's no refund policy and as per 46 CFR 67.500(e)

Payment Information

Card Details

Cardholder Name

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BILLING ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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