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Gifford Street Dinghy Rack
Port of New Bedford Mooring Rules & Regulations
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Instructions
Please submit this form using any of the contact methods provided below.
Instructions
Provider Name
New Bedford Port Authority
Provider Mailing Address
123 MacArthur Drive
New Bedford, MA 02740
Provider Phone
508-979-1456
Provider Email
gregg.pupecki@newbedford-ma.gov
Application
Application Sticker Number
Would you like Facilities Access?
Applicant
First Name
Middle Name
Last Name
Contact Information
Primary Phone
Alternate Phone Number
Mobile Phone
Work Phone
Email Address
Emergency Contact
Emergency Contact Name
Emergency Contact Home Phone
Emergency Contact Email
Additional Information
Emergency Contact Address
Vessel
Vessel Name
Hull ID
Vessel Type
Size
Length
feet
inches
Draft
feet
inches
Characteristics
Vessel Color
Engine
Engine Make
Dinghy
Dinghy Reg or Doc #
Insurance
Insurer Name
Insurer Phone
Insurer Policy Number
Accessories
MSD
Other
Insurance Expiration Date
Berth
Mooring Type
Inspection
Service Provider
Primary Tackle
Block Type
Anchor Weight
Chain Diameter
Chain Length
Top Chain Diameter
Top Chain Length
Pennant Diameter
Pennant Length
Attachments
Attach a paper copy of each attachment listed below:
Proof of Vessel Insurance
*
Inspection Report
Acceptance
Terms and Conditions
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I have read and understand the Online Mooring
User Terms and Conditions
Signature
Date
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