Dealer Bond - Used Car

$35,000 Used Car Dealer Bond

USED CAR DEALER BOND
$35,000.00 BOND LIMIT
Please note by submitting this form, you agree that all information is true.
Are you the Owner, Officer or Member? Required	YES NO
If you answered "NO", stop and have the Owner, Officer or Member complete the application
Personal Information
First Name Required
Last Name Required
Legal Name of Business Required
DBA Name Optional
How many years in business under your legal name? Required
Business Type Required	Corporation Sole Proprietor Partnership LLC Other
Federal ID # (If you don't have type "Don't Have") Required
E-Mail Address Required
Mailing Address Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
Primary Phone Number Required
Business Street Address Required
City, State, and ZIP Code Required
Is the Bond for a start up operation or an existing business? Required	Existing Business Start Up Business
Owner's Personal Information
Number of Years as a Licensed Dealer? Required
Owner's Name (Officer or Member) Required
Owner's SSN for Credit to be obtained Required
Owner's Date of Birth Required
Owner Married or Single Required	Married Single
If Married, the Insurance Company requires your spouse's name. If not married, "Type Not Married". Required
Owner's Residence Address Required
Do you own a Home? Required	Yes No
Do you own Commercial Real Estate? Optional	Yes No
Any Prior Bond Claims for Owner or Business? Required	No Prior Bond Claims Yes there has been a prior Bond Claim
Has Owner ever been convicted of a CRIME? Required	Yes No
If owners has been convicted of a crime, List Year and Description Required
How many years experience does Owner have in Dealership Industry? Required
Any other Officers or Owners of this Business? Required	Yes No
If additional Officers or Owners, how many? Enter 0 if none Required
Do you currently have a Dealer Bond? Required	Yes No
If Yes, Name of Bond Carrier. If No, Type "NA" Required
How did you hear about us? Please let us know Required
SIGNATURE REQUIRED
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge.
By typing my name warrants my signature. Required
You agree all information is true to the best of our knowledge and you agree to allow us to obtain your credit history for insurance purposes. Required	Yes, I agree & obtain my credit for insurance No, cancel my request
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Submission Validation Required	Enter the Validation Code from above.

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