Berth Assignment

Port of Palm Beach District

Attention: Dock Master
fax: 561.841.0623
email: dockmaster@portofpalmbeach.com

 

 

** Form cannot be submitted until all spaces are filled.
Items must be filled in order for form to submit.**

 

where an item is not applicable to your vessel, insert "NA"

 

Vessel Name:   Call Sign:  
Official Vessel Number:   Vessel Flag:  
Berth Requested:   Length:  
ETA:

 

 Gross Tons:  
ETD:

 

 Beam:  
Agent:   Draft:  
Stevedore:   Vessel Phone:  
ISPS Certificate # :   Cargo:
Inbound Outbound
Current Vessel MARSEC Level  
1 2 3
Description of Cargo:  
Hazardous Materials on Board:

 

 Tonnage:  
  Select One:
RO/RO LO/LO  BARGE/TUG
  Agent E-mail Address:  
Cranes Ordered:   Agent Contact (24HR) #:  
    Stevedore Contact #:  
For the Above Listed Vessel: This is a 72-hour notice of arrival Hot Work Permit Requested: yes no
  This is a 36-hour notice of arrival Water Service Requested: yes no
  This is a 24-hour notice of arrival Line Handlers Requested: yes no
    Last Port:  
    Next Port:  

 

for questions/concerns, please call: 561.383.4194/4195

 

REMEMBER: ALL FIELDS MUST BE FILLED OUT FOR US TO ACCEPT

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