National Park Service
U.S. Department of the Interior
Glen Canyon National Recreation Area
Page, Arizona
Commercial Use Authorization - Application Request Form
Name:____________________________________ SSN or Fed Tax ID #:_____________________
Company Name:___________________________________________________________________
Mailing Address:___________________________________________________________________
City/State/Zip:_____________________________________________________________________
Physical Address (if different from mailing address):_______________________________________
City/State/Zip:_____________________________________________________________________
Business Phone: _____________________________ Fax:_________________________________
Cell Phone:__________________________________ Pager:_______________________________
Email:_______________________________ Website URL: ________________________________
Business is being conducted as (check one):
Sole Proprietorship Partnership Corporation Limited Liability Company
Other:_________________________________________________________________________________________
Person(s) authorized to sign on behalf of the business (name and title):_______________________
________________________________________________________________________________
Type of CUA requested (check all that apply):
Guided Kayak/Canoe & Launch, Retrieval & Boat Hauling – Vessels &
Vessel Caretaking
Instruction Houseboats (Privately Owned Only)
Guided Fishing Guided Hunting Minor Vessel Repair
Guided Backpacking/ Land-Based Tours
Scuba Diving Excursions & Instruction
Hiking (Backcountry Roads)
Marine Salvage Waterski/Wakeboard Instruction
Rev. 01/19/07 Page 1 of 2
Description of Services to be provided under the CUA:_____________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Locations where services will be provided (check all that apply):
Wahweap Stateline Bullfrog Halls Crossing
Hite Backcountry Lake Powell Lees Ferry
COMMENTS:_____________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
I certify the information provided on this form is true and accurate to the best of my knowledge.
SIGNATURE:_____________________________________________ DATE:__________________
Mail this request form to:
National Park Service
Glen Canyon National Recreation Area
Attn: CUA Program
P.O. Box 1507
Page, AZ 86040-1507
or Fax: 928-608-6259
Rev. 08/25/06 Page 2 of 2