Office of the Harwich Harbormaster Fax Completed Form To:

Saquatucket Municipal Marina 508-430-7535

715 Main Street

P.O. Box 207

Harwich Port, MA 02646

2010

Boat Ramp Trailer Pass Application

Salt Water Ramps & 1^st Landing Long Pond

Owner’s Name_____________________________________________ Date____________________

Permanent Mailing Address: Number & Street_____________________________________________

City__________________________State_________Zip_____________

Summer Address: Number & Street_____________________________________________

City__________________________State_________Zip______________

Phone Numbers: Home______________________Work___________________Cell_______________

Type of Boat___________________________Length_________Class/Make______________________

Boat Name: ____________________________________________________________

Boat Registration #__________________________Trailer Plate Number_________________________

Fees: Private Boat Trailer: $100.00 / trailer

Please send your completed application and check payable to the Town of Harwich at the above address. After receipt of your check and application, you will receive your new annual Boat Ramp Pass and the complete Rules & Regulations governing Boat Ramps in the Town of Harwich. This pass is only valid for launching your boat and parking at Allen Harbor Landing, 1^st Landing Long Pond and Saquatucket Municipal Marina. If you have any questions regarding this application, please contact the Harwich Harbormaster’s Office at 508-430-7532.

CREDIT CARD TOTAL AMOUNT $__________________ VISA or MASTERCARD

CREDIT CARD #:_______________________________________________________________

Expiration_________________ Auth. Code (3-digit # located on back of card):______________

The issuer of the card identified on this form is authorized to pay the amount shown as Total Deposit Amount upon proper presentation. I promise to pay such TOTAL (together with any other charges due thereon) subject to and in accordance with the agreement governing the use of such card.

Signature: ___________________________ Date: ________________

Either mail in this form with deposit check made payable to the Town of Harwich or (because we do not have a secure website) fax this form signed with credit card information and we will debit your Mastercard/Visa account for the amount you have acknowledged. A receipt will be sent by return mail to you for your records. Sorry we do not take any other credit cards.

Do Not Write Below This Line

Ramp Pass #______Treasurer Payment #_____Date received_______