Motor Vehicle Dealer Bonds

Additional information will be required prior to issuing the bond.
For court and fidelity bond needs, please contact our office prior to completing the application.

BOND INFORMATION

MM slash DD slash YYYY
Obligee Address:
MM slash DD slash YYYY

BUSINESS INFORMATION

Company Address(Required)
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MM slash DD slash YYYY
Please enter a number greater than or equal to 0.
Please enter a number greater than or equal to 0.
Ever had their business license suspended, revoked or denied?
Person 1

All owners including spouses must complete "Personal Information" - Add more sheets if necessary
US Citizen ?
Date of Birth
US Citizen? (Spouse)
Date of Birth
Address(Required)
Ever been convicted of a crime?
Are you the Trustee, Trustor, or Beneficiary of any Trust?
Ever Declared Bankruptcy?
Pending or Prior IRS Liens?
Any Lawsuits Pending against you?
Ever declined for Bonding Previously?
Home Ownership?

Are there any current or prior claims? If yes, please explain.(Required)
Is there a current bond in place? If yes, please explain reason for obtaining a new quote
Drop files here or
Max. file size: 5 MB, Max. files: 5.
    If you are an insurance agent, please complete the following
    If you are not an insurance agent and completing this application for yourself, please include the following.

    The individual named above, who is the owner/officer/related party of the applicant for this bond/policy, requested that this application be submitted to the Company (Construction Capital, Inc./CCI Surety, Inc.) for the purpose of “Underwriting” (determination for acceptability; potential, actual or future pricing; and other related services) of this bond/policy. A copy of such request for “Underwriting” of the bond/policy requested by the above individual was provided to and is maintained by this agent/agency. Further, this agent/agency discussed with the owner/officer/related party named above concerning the use of his/her personal credit history to facilitate the “Underwriting” of the applicant and received consent to use his/her personal credit history for such Underwriting purpose.

    Vermont: If the owner/officer/related party of the applicant is a resident of the state of Vermont, the Agent shall obtain the written consent of such individual owner/officer/related party stating that: “The individual owner/officer/related party of the applicant understands and agrees that by submitting the application for the bond or insurance on behalf of the applicant that his/her personal credit history may be obtained and used to facilitate the underwriting process (determination of acceptability; potential, actual or future pricing; and other related services) of this application.” Also, the Agent agrees to retain copy of this written consent for the Surety.