YOUR INFORMATIONFirst Name:* Last Name:* Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone: *(Home)(Work)(Cell)Email:* Commercial (Charter) Activity* I will not be using my boat or mooring assignment for any commercial activity of any kind. I have and will be renewing a current and valid commercial permit. I did not have a commercial permit but intend to apply for one. Commercial activity is the renting or leasing of your boat or permitted mooring and/or accepting any monetary compensation related to your permit.Invoice Information (Required)Invoice Date*"Printed on" date above Account # MM slash DD slash YYYY Account Number*Printed on invoicePIN Number*Required or payment will not be acceptedTOTAL DUE*DO NOT DEDUCT FROM TOTAL DUE!!! If you wish to make any changes, contact the Chicago Harbors officefor a revised invoice.Payment InformationThis field is hidden when viewing the formNumberPayment Option* 1/5 Payment Pay in Full Payment Option* 1/4 Payment Pay in Full 1/5 Installment Payment1/4 Installment PaymentPayment in FullJudd Goldman Adaptive Sailing Program DonationComments:PAYMENT SUMMARYPayment Amount* Price: $0.00 Judd Goldman Donation Price: $0.00 This field is hidden when viewing the formSub-TotalElectronic Transaction fee Price: Total Payment Price: $0.00 PAYMENT INFORMATIONA 2% late fee will be applied to all past due balances. Major credit cards accepted with a $8.00 electronic transaction fee on charges greater than $1,000.00 Debit card users should contact their bank/card issuer to authorize the payment if it exceeds their daily limit.Name of Card Holder:* Billing Address Click here if credit card billing address different than address on invoice Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name By clicking here the permittee agrees to abide by all regulations and laws of the Chicago Park District, the City of Chicago, State of Illinois and the United States. Violations of these regulations and laws may result in the revocation of permits and/or fines. Permittee also agrees to release, indemnify, and hold harmless the Chicago Park District and its officers, employees, agents, servants, successors, assigns and contractors from any and all liability or claims arising from the permittee’s use of the harbor system, resulting in damage to boats and personal injury to the permittee and his/her guests. By submitting this form, I acknowledge that the above information is true and accurate and I am in accordance with the rules and regulations of the Chicago Park District governing the use of harbors.Payment processing may take up to 72 hours. New applicants should verify payment has been applied to their account before bringing in their boat and checking in at their harbor. CONFIRM PAYMENT AMOUNT* I confirm the payment amount below Total Payment Price: $0.00
312.741.3601
312.741.3601
312.741.3601