CG-7042 (05/20) Authorization for Credit Card Transactions

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
AUTHORIZATION FOR CREDIT CARD TRANSACTIONS

OMB No: 1625-0027
Expires: 04/30/2023

A. DATE

B. FROM

C. TELEPHONE NUMBER

D. VESSEL NAME

E. HULL IDENTIFICATION # OR OTHER UNIQUE IDENTIFIER (IF ANY)

F. CREDIT CARD HOLDER’S NAME

G. CREDIT CARD NUMBER (WE ACCEPT VISA, MASTERCARD, AMERICAN EXPRESS OR DISCOVER)

H. EXPIRATION DATE

I. AMOUNT OF CHARGE

K. OFFICIAL # OR HIN

J. VESSEL USE/ENDORSEMENT (CHECK ONE)
REC
COM

L. INDICATE SERVICE REQUIRED
Visit our website at http://www.uscg.mil/nvdc for complete Fee Schedule
Application Fees (Initial, Exchange, Return, and Replacement) Amount $ ____________
Certificate of Ownership (CG-1330) Fee $125.00
Copy of General Index or Abstract of Title Fee $25.00
Certified Copy of Certificate of Documentation w/Seal Fee $4.00
Deletion Letter $15.00
Bill of Sale $8.00/page
Application for Renewal $26.00
Application for Late Renewal $5.00 (include $26.00 Renewal fee for a total of $31.00)
Other __________________________ Amount $ ____________

APPLICATION FEES ARE NOT REFUNDABLE (46 CFR 67.500 (d )).

M. REQUESTOR NAME & ADDRESS

N. TELEPHONE NUMBER

O. FAX NUMBER

P. E-MAIL ADDRESS
ATTN:

FOR COAST GUARD USE ONLY
Q. NAME OF PERSON TAKING REQUEST

1.
2.
3.

4.

R. DATE PROCESSED

PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, DEPARTMENTAL REGULATIONS; 46 U.S.C. CHAPTER 121, DOCUMENTATION OF VESSELS.
PURPOSE: COLLECT USER FEES FOR SERVICES (E.G. VESSEL DOCUMENTATION, BILL OF SALE, CERTIFICATE OF OWNERSHIP, ETC.)
PROVIDED BY THE USCG NATIONAL VESSEL DOCUMENTATION CENTER (NVDC).
ROUTINE USES: AUTHORIZED USCG PERSONNEL WILL USE THIS DATA TO ASSESS AND ACCOUNT FOR VARIOUS USER FEES
CHARGED BY THE NVDC. ANY DISCLOSURES OF DATA WITHIN THIS RECORD WILL BE MADE IN ACCORDANCE WITH DHS/USCG-013,
MARINE INFORMATION FOR SAFETY AND LAW ENFORCEMENT (MISLE), 74 FEDERAL REGISTER (FR) 30305, JUNE 25, 2009, AND
DHS/ALL-007 ACCOUNTS PAYABLE SYSTEM OF RECORDS, 80 FEDERAL REGISTER (FR) 58286, SEPTEMBER 28, 2015.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: VOLUNTARY. HOWEVER, NO DOCUMENTATION SERVICE FOR WHICH A
FEE IS APPLICABLE WILL BE PERFORMED UNTIL THE APPROPRIATE FEE HAS BEEN PAID, AS PER 46 CFR PART 67.500.

THE COAST GUARD ESTIMATES THAT THE AVERAGE BURDEN FOR THIS FORM IS 5 MINUTES. YOU MAY SUBMIT ANY COMMENTS
CONCERNING THE ACCURACY OF THIS BURDEN ESTIMATE OR MAKE SUGGESTIONS FOR REDUCING THE BURDEN TO: U.S. COAST
GUARD, NATIONAL VESSEL DOCUMENTATION CENTER, 792 T J JACKSON DRIVE, FALLING WATERS, WEST VIRGINIA 25419, OR OFFICE OF
MANAGEMENT AND BUDGET, PAPERWORK REDUCTION PROJECT (1625-0027), WASHINGTON, DC 20503.
CG-7042 (05/20)

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