Application for Tribal Fish Dealer

Application for Tribal Fish Dealer

Or Tribal Buyer Card for Current Year
Business Name (if applicable)
Tribal Business License Number
Name of Business Owner/Manager *

First NameLast Name
Tribal ID Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number
Please enter a valid phone number.
Check one:

Owner/managerBuyer/employee
Treaty ID Number
Shellfish Certificate Number (if applicable)
Name*

First NameLast Name
Home Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Buying Location (port)
Is this a new application or a renewal?

NewRequest fish ticketBook renewal
Previous license #
I HEREBY CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE NOOKSACK TRIBE THAT THE ABOVE INFORMATION IS TRUE AND CORRECT
Signature.*

Clear
Date

MonthDayYear
Date
If you would like a confirmation of receipt of this document, please include your email:
example@example.com
TRIBAL MEMBERS WORKING FOR A STATE LICENSED DEALER WHO BUYS TREATY CAUGHT FISH/SHELLFISH MUST BE LICENSED.
Should be Empty: