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MVD Dealer Bond

 

Motor Vehicle Dealer License Bond - Multi-State
Online Application Form

A credit check will be required for this DMV Dealer Bond. 

 We will Confirm Rate and Term Prior to processing your payment. 

Required Items (*)
State: *


County
   
 

 

Bond Amount Required: *
 

 

Bond Term Required by MVD  
Required Expiration Date or Year     


Years in this Business*          Years Experience*  
      Number of Years Licensed*     

New Car Dealer     Used Car Dealer

                                                                            Franchise    Independent

   License No. *      Previously Bonded   

  Prior Surety Co.

    Why Change? 
 
***Name to appear on auto dealer bond  (Business Name)*
   
     Business Phone*  
     Business Email *   

***Print the name exactly as it is to appear on the bond.
***This may be the same as your full name, a DBA, a corporation, etc.

 

Please be advised - RE: Your DMV Dealer Bond


The Dept. of Motor Vehicles requires this to be exact. They will reject your
bond if any letter, comma, period or word is either missing, added or wrong
YOU MUST VERIFY WITH DMV THE EXACT NAME WORDING!***


Once issued, there will be a $35 fee to make any corrections of information
originally provided by you.
 

CHECK HERE CONFIRMING ABOVE NAME IS AS IT SHOULD APPEAR ON
THE BOND

OWNER INFORMATION *

Owner / Indemnitor 1  
Social Security Number  
Address Line 1
Address Line 2
City
State Zip code         
Home /Cell Phone  
Email  
Marital Status    
Real Estate:   Do you own real estate? No Yes
  Real Estate Total Equity 
 
Owner / Indemnitor 2
Social Security Number
Address Line 1
Address Line 2
City   Zip code 
State
Home /Cell Phone
Email
Marital Status    
Real Estate:   Do you own real estate? No Yes  
  Real Estate Total Equity 
   
 If more owners, submit additional  information in Comments below

Requested effective date / /      


 Leave this blank if you wish your bond to become effective the same day it is issued. 
You may request to have your bond become effective at any date in the future, or up to 30 days in the past.

Mailing Address


South Coast Surety will mail the bond to this address.
Address Line 1
Address Line 2
City
State
Zip code

Business Mailing Address 


Same as mailing address.
Address Line 1
Address Line 2
City
State
Zip code

Payment Information
We recommend that you enter your credit card information now because it helps us
to get your bond mailed to you quickly. *
We will not bill you until the bond is in the mail to you. 
You may leave it blank and we will contact you within two working days with a
premium quote and information on how to pay by check.
We accept: Visa or MasterCard.*
*There is a 6% fee added for all on line transactions.

Credit Card Number           3 Digit Security  Code
Expiration Date /
Name appearing on credit card

Credit Card Billing Address


Same as mailing address.
Address Line 1
Address Line 2
City
State
Zip code
   
Referred By    

 Comments
 
 

For Appointed Brokers*
Broker Code 
Broker Name
*need filled in to receive commission


 
Premiums for On-Line Applications are fully earned upon approval and payment.



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