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Bond Category:  Commercial  State:  California  Bond Name:  DMV Motor Vehicle Dealer Bond - 10K 
Complete the web form below to receive the lowest possible rate for your bond.
Note: Fields marked with an (*) asterisk are required.
Enter information as thoroughly as possible to avoid any delays in processing.

Bond Information:

  Type of Bond
  Bond Amount
*Effective Datecalendar
  Bond Term

Business Information:

*Company Name

Exactly as it should appear on the bond.

*Length of Current Ownership
*Business Phone
  Business Fax
*Email Address
  License Number

  Number of Owners

If Partnership or Corporation - Number of partners or stockholders.

Indemnitor (Responsible Party) Information:

*First Name
  Middle Name
*Last Name
*Drivers License Number

Indemnitor's Spouse (If Indemnitor is Married or Separated - All items are required):

  Full Name of Spouse (First, Middle, Last)

Real Property Information:

*Home Ownership
*Home Phone
  Home Fax
*How Long in Home

If Home is Owned:

  Purchased Datecalendar
  Purchase Price
  Current Market Value
  Current Home Loan Balance

Personal Financial Information:

*Name of Bank
*Checking Account Balance
*Savings Account Balance
*Personal Net Worth

Some bonds may require a Personal Financial Statement.

I understand that by submitting this application I give permission to Pacific Coast Surety and Insurance Services/ and or surety to obtain a credit report for the individuals listed. Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.

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