SOUTH COAST SURETY

Texas Contractor License Bond
Online Surety Bond Application Form

Please Complete all fields (Application may be rejected if all information is not provided)                Please Call With Any Questions 1-800-361-1720

A credit check will be required for this Texas License Bond.*
Upon credit approval your credit card will be charged and the bond will be issued.**

Please Select Company Type: Individual Partnership Corporation Limited Liability Company Limited Liability  Corporation RME /RMO 

                Texas Contractors License Bond Classification (Please enter exact contractor license class). Additional Space in Comments Below. 
                                                                                                                         

   Classification:   
                                  Class #                                                Class Description                                                                      Bond Amount
                                      
   Texas Contractors License Number        

If you have a license number with the Contractor's State License Board enter it here.  If you are applying for a new license and do not have a license number you must enter your Application Fee Number.

Name to appear on Texas Contractors License bond  

This name must match the name that is or will be on your contractor's license.   Business Tax ID#

 
Name of person who will sign for this bond     Percent Owned 

If the name appearing on the bond is a business or corporation, this must be the name of the owner or president.  If the name appearing on the bond is an individual, then the name is the same. If multiple owners  PLEASE HAVE ADDITIONAL OWNERS COMPLETE ADDED APPLICANTS BELOW

  Same as name appearing on bond.  

Please Indicate:   Marital Status  Select Marital Status Single Married  Own Residential Real Estate? Yes No     Net Worth

          Social Security Number     Number of Years in Business?     Number of Years Licensed?
                                                                        

Requested effective date 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 2007 2008 2009 2010 2011 2012 2013 2014      County

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.

Home Address

Address Line 1
Address Line 2
City	State
Zip code	Phone No.

Business Mailing Address

Same as home address.

South Coast Surety will mail the contractor license bond to this address.

Address Line 1
Address Line 2
City
State
Zip code

Business phone number                       Fax number                           E-mail address 

Area	Phone Number	Extension                   Area    Phone Number

Payment Information
We recommend that you enter your credit card information below to expedite receiving your bond. *
We will not bill you until the bond is approved and issued. 
You may leave this blank and upon approval we will contact you with a premium confirmation and information on payment options.
We accept: Visa or MasterCard.*
*There is a 6% fee added for all credit card transactions.

Credit Card Number	3 Digit Security  Code
Expiration Date	Month 123456789101112 / Year 200820092010 2011 2012 2013 2014
Name appearing on credit card

Credit Card Billing Address

Same as Mailing address    Same as Home address.

Address Line 1
Address Line 2
City
State
Zip code

If RME / RMO (BOND OF QUALIFYING INDIVIDUAL) COMPLETE THE FOLLOWING:
Name of Firm on License
Company Address
City / State/ Zip
Company Phone   Company Fax

ADDITIONAL Texas CONTRACTOR LICENSE BOND APPLICANTS

Name       Percent Owned        Marital Status  Select marital Single Married 
  Own Residential Real Estate? Yes No     Net Worth     Social Security Number 

Address Line 1
Address Line 2
City	State
Zip code	Phone No.

Name     Percent Owned     Marital Status  Select marital Single Married 
Own Residential Real Estate? Yes No     Net Worth            Social Security Number 

Address Line 1
Address Line 2
City	State
Zip code	Phone No.
Referred By   Please Select Referral Source Search Engine Personal Referral Yellow Pages Radio Direct Mail Other- Enter Below Comments/Requests:

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