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Freight broker test
Freight Broker Bond Application
Bonding Information
Type of Bond:
Bond Amount:
Effective Date:
Who is Requiring you to get this Bond (Obligee):
Obligee Address:
Current Surety (If any):
Current Rate or lowest Quote:
General Information
Owner
Applicant Name:
Social Security Number:
Spouse Name:
Spouse Social Security Number:
Personal Address:
City:
State:
Zip:
Partner/Additional Owner
Applicant Name:
Social Security Number:
Spouse Name:
Spouse Social Security Number:
Personal Address:
City:
State:
Zip:
Business Information
Business Name:
Motor Carrier or Freight Forwarder Number:
Business Address:
City:
State:
Zip:
Tax ID (FEIN):
Business Phone:
Cell Phone:
Email:
Date Business Began:
What Brokering Experience Does the Owner Have:
Owner(s) Additional Underwriting Questions
Have you Ever Caused a Loss to a Surety?
Yes
No
Have you Ever Files For Bankruptcy?
Yes
No
Any Liens, Claims or Judgements?
Yes
No
Do You Own Real Estate?
Yes
No
Do You Understand that You are Responsible for any Claim Payouts?
Yes
No
Do you plan on using a factoring Company?
Yes
No
If Yes, Name:
If No, What Resources Do You Have to Float Payment in the Event Youf Payments Are Made to Carriers/Shippers? Please Explain Below:
What Safe Guards Do You Have To Make Sure That Timely Payments Are Made to Carriers/Shippers? Please Explain Below:
Are you married?
Yes
No
Spouse Name:
Spouce SSN:
Do you have a partner?
Yes
No
Partner Name:
Partner SSN:
I assure the above information is accurate and truthful. Bonding Solutions, LLC and appointed sureties will use this information, including credit reports, to obtain surety bond terms on my behalf.
By checking this box I agree to the
terms and conditions
.
By checking this box I agree to the
surety indemnity clause
.
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Person Signing for above referenced name and company
First Name
Last Name
Date:
Submit Bond Request
Please call
480.835.6745
with any questions.
Questions?
Call us today to speak to a Surety Bond Specialist
(877) 841-6745
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