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Dealer Bond – Used Car

$35,000 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)

If you answered "NO", stop and have the Owner, Officer or Member complete the application

Personal Information

Full Name

First Last

Legal Name of Business(Required)

DBA Name

How many years in business under your legal name?(Required)

Business Type(Required)

E-Mail Address(Required)

Mailing Address(Required)

City State / Province / Region ZIP / Postal Code

Primary Phone(Required)

Physical address of Dealer's Lot(Required)

City State / Province / Region ZIP / Postal Code

Is the Bond for a start up operation or an existing business?(Required)

Owners Personal Information

Number of Years as a Licensed Dealer?(Required)

Owner's Name (Officer or Member)(Required)

First Last

Date of Birth(Required)

Owner Married or Single(Required)

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)

Do you own Commercial Real Estate?(Required)

Any Prior Bond Claims for Owner or Business?(Required)

Has Owner ever been convicted of a CRIME?(Required)

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)

If additional Officers or Owners, how many? Enter 0 if none(Required)

Do you currently have a Dealer Bond?(Required)

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)

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.