Surety Bond Insurance Agent Application

We can write surety bonds for insurance agents. we are always looking to help surety bond agents write surety bonds. If you are having trouble, placing a surety bond just fill out the application below and we will get back to you with a surety bond approval within twenty four hours. If you have been declined by your surety markets it's OK in most cases we still can offer an approval for your surety bond without collateral. We represent a vast number of markets with flexible underwriting. we only deal with A rated T-listed surety companies. We offer agents a competitive commission/fee structure starting at 15% Surety bonds are issued within one to two days after the receipt of the GIA and the terms and conditions of the surety company have been met.  Do you want to learn more before you apply for the surety bond?

By filling out this application you are giving the surety company consent to obtain a credit report

TERMS AND CONDITIONS

1.I understand false statements may result in forfeiture of benefits and possible prosecution by the US Attorney-General Any person who knowingly and with the intent to injure, defraud, or deceive any insurer (Surety Company) files a statement of claim or an application containing false, or misleading information is guilty of a felony
2. The above is only a conditional offer and is subject to change or rescission based upon a multitude of considerations.
3. The above quoted may include a broker fee. Therefore, the undersigned hereby agrees that if a fee is charged, to pay the fee in the amount.
4. If the Surety Bond is canceled the commission shall also be considered a fee, and fully earned.
5.  Integrity Bonds Inc. may also be acting on behalf of the insurer issuing the subject Surety Bond(s) or insurance and will be receiving a commission.    This agreement shall serve as the writing required pursuant to the rules set forth by your Department of Insurance (Broker/Agents shall comply with their applicable state regulations regarding fees).Fees include premium, processing, state tax, surplus tax, brokers and commission fee where applicable

Insurance Agent Information Form All Fields Are Required if not actable please just type N/A NAME (MUST BE EXACTLY AS IT IS ON BOND)   THIS BOND IS FOR A (AN):   Sole proprietor Partnership Corporation      LLC Street Address:   City:   County:   State:   Zip Code:   E-mail:   Business Telephone:   Fax:   Your Name:   Title:   Spouse's name:   Prior Bond Co:   Corp tax ID if any:   Year of experience in this field:   Date Business Started   Soc. Sec. No.:   D.O.B.:   Spouse's Soc. Sec. No.:   Home Address:   Home Phone:   Home City:   Home State:   Home Zip:   Real Estate Owned Values:   Mortgage $ Owned:   Value of Securities owned:   AGENCY INFORMATION Agency Name:   Contact Name:   Agency E-Mail Address:   Agency Phone Number:   Agency Fax Number:   Has applicant ever; (a) had an application for a bond declined; (b) compromised with creditors; (c) defaulted on a contract; (d) defaulted on a contract forcing a Surety to suffer a loss; (e) experienced a bankruptcy; (f) been in receivership or been liened by a taxing No (If yes to any of the above, attach a full explanation.) Yes authority?   Yes No BOND REQUIRED Type of bond:   Effective Date:   Amount:   Comments Section (I.E. BOND FORMS, APPLICABLE STATUTES AND PERMITS, COURT JUDGMENTS, ETC.) PLEASE ENCLOSE ANY ADDITION PERTINENT INFORMATION   (Who is requiring the Surety bond) Obligee:   Obligee Address:   Obligee State:   BUSINESS INFORMATION DATE BUSINESS ESTABLISHED:   Bank Reference: NAME & BRANCH OF BANK:   Bank Balance:   Line of Credit $:   Account No:   Number of years experience in this field   I Acknowledge and Authorize Integrity Bonds to pull my credit report    Yes      No Digital Signature (must type in your name):   Please tell us how you found us:   Please Select One ----> 2savvy Alltheweb AltaVista America Online AOLFind Ask Jeeves Excite Google Go Goto Hotbot Infoseek Lycos MSN Northern Lights Snap Web Crawler Yahoo Banner Ad Friend Website News Group Magazine/Newspaper Radio Other Comments/Questions:   Private Information. All information will be kept confidential.