Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEIN # or SS#We will provide you with a 1099 at the end of the year.Name of your Charter Company if applicable.Provide Merchant Mariner Credential (MMC) Credential type and serial number. OR Mariner Reference Number. We check the status of a captain’s license on the Coast Guard websiteHow long have you been doing this? *I will add Salty Fish Excursions as an additioal insured to my business insuranceYesCompany Address or Home Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMust have complete information to be able to be set up for payment.Email *Phone *How would you define good customer service *Describe your personality, how would your friends describe you? *Signature * Clear Signature use mouse to sign your first and last name Date / Time *DateTimeSubmit
