(Note: The 2013 Trap Purchase Program was created to increase lobster poundage sold through the Pemaquid Fishermen's Co-op. Applications are subject to review and approval by the Pemaquid Fishermen's Co-op Board whose decisions are final.)

Date ______________

Last Name ___________________ First Name _____________
Middle Name__________________

Street Address _______________________________________________

City _____________________ State _______ ZIP _______

Telephone ___________________________
Lobster License # ______________

Port of Origin? __________________________________________

How did you hear of the Pemaquid Fishermen's Co-op Trap Purchase Program?

What is your annual poundage average? ___________________

What percent of your catch are you planning to sell through the Pemaquid
Fishermen's Co-op? (Minimum of 50% required) ____________

Desired Traps? _____________
Source of traps? ____________________________

Are you interested in joining the Pemaquid Fishermen's Co-op ? (Not Required For Program Participation) Yes   No

Have you ever declared bankruptcy? Yes    No

If yes, please describe circumstances_______________________________
Current Lobster Buyer Company Name _____________________________________________________________

Attach additional information if necessary.

Signature____________________________________ Date __________

Please contact Wayne or Ann with questions regarding membership in the Pemaquid Fishermen's Co-Op:
E-Mail Wayne at:
E-Mail Ann at:
Phone: 207-677-2801
Fax: 207-677-2818
Cell: 207-350-0781 (Wayne)


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