If individual bond amount exceeds $50,000 or the aggregate amount of bond(s) per applicant exceeds $100,000 an advisor will contact you for additional underwriting information. No financial statements required for bonds not exceeding $50,000.Application is hereby made to Harvard Western Insurance for a:*-select option-Automobile/Motor (or Used Car) Dealer BondAuctioneers' License BondBonded Carrier Operations (Highway)Carnet BondClaim's Adjuster BondConsumer Protection/Direct Seller BondPrivate Investigators & Security Guards BondCustoms Sufferance WarehouseElectrician's License BondExcise BondLicense Plate BondLivestock Dealer BondContractor's License BondCustoms Bonded WarehouseReal Estate BondGeneral Surety Bond TypeContact Name*Phone*Email* Applicant (full name in which bond is to be issued):*Complete Postal Address:*Postal Code:*Business Number:*Nature of Applicant's Business:*How long in Business:*Obligee (to whom is this bond payable?)*Obligee Address:*Bond Amount:*Bond Term:*-select option-1 year2 years3 yearsHas the applicant, or its shareholders, ever been bankrupt or insolvent?* Yes No Has any Surety ever declined to issue a bond for this applicant?* Yes No Consent* Has the applicant (and shareholders if applicable) consented to the collection, use and disclosure of the information requested on this form by HWI for the purposes of risk assessment, providing services, investigating claims, processing claims and any other purpose authorized by law.
