Motor Vehicle Dealer Bond Application
Applicant Name (as it will appear on the bond)
Company Name
FEIN #
# of Years in Business
Business Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Are you a member of any automotive dealer associations?
Yes
No
Name of association
Bond amount
$50,000
$75,000
$100,000
Other
Owner Name
First, Last
Owner Social Security #
Are there additional owners?
Yes
No
Additional Owners
Has any applicant/ owner/ indemnitor ever been convicted of a felony or crime involving dishonesty, including theft or fraud?
Yes
No
Has any applicant/ owner/ indemnitor ever had a bond claim filed or paid against them?
Yes
No
Does any applicant(s) have any suits, liens or judgments filed against them?
Yes
No
Has the requested bond been declined by another Surety Company?
Yes
No
Please provide details to anything you indicated yes for above
Submit
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