CALL Toll Free
800-331-5453


Alaska Motor Vehicle Dealer Bond - $50,000 Online Application
To get the lowest price possible for your bond, and to get a response within the next two hours, enter your information in the fields below and click the "Submit" button.


Note: Fields marked with an asterisk are required.
*Are you an insurance agent completing this application on behalf of a client? Yes No
Click Here to view an example of this bond form.
Please note: This bond form is for illustration only and is not necessarily the latest bond form issued by the obligee. All bonds will utilize the current bond form as issued by the obligee at the time the bond is written. We will provide the bond form unless the obligee has instructed us to use the bond form they have provided to you.

Enter the applicant name/business name below exactly as it should appear on the bond. The applicant name should match the name on your license, if a license is held.
*Business Name:  
*Business Address:  
*Business City:  
*Business State:  
*Business Zip:  
*Owner's Name:  
*Are you the only owner?   Yes No
*If no, how many other owners are there?  
*Phone Number:  
*Fax:  
*Email:  
*Home Address (include apartment number, if applicable):  
*City:  
*State:  
*Zip:  
*Are you married?   Yes No
*Your SSN:  
*Business Type:
*How long have you owned this business?  
*How many years experience do you have in this industry?:  
*Name to go on Bond:  
*Amount of bond $
Have you ever had claims?  Yes No
*Facility Number:  
Note: If you do not have the facility number, you may enter "none".
*Dealership License Number:  
Note: If you are a new dealership and applying for the first time, simply enter "none".


Please enter the requested financial information below. Please do not enter periods or commas in the boxes. Enter numbers only.
WHAT YOU OWN
*Cash on hand and in banks: $
*Government securities: $
*Listed securities: $
*Unlisted securities: $
*Loans receivable: $
*Real estate mortgages receivable - secured by real estate mortgages, deeds of trust: $
*Real estate owned: $
*Automobiles and other personal property: $
*Cash value of life insurance: $
*Other assets (please itemize below): $
TOTAL ASSETS: $
 
WHAT YOU OWE ON WHAT YOU OWN
*Notes payable to banks (secured): $
*Notes payable to banks (unsecured): $
*Notes payable to others (secured): $
*Notes payable to others (unsecured): $
*Accounts & bills due: $
*Unpaid income tax: $
*Other unpaid taxes & interest: $
*Real estate mortgages payable: $
*Chattel mortgages & other liens payable: $
*Other debts (please itemize below): $
TOTAL LIABILITIES: $
NET WORTH: $
 
SOURCES OF INCOME
*Salary: $
*Bonus & commissions: $
*Dividends: $
*Real estate income: $
*Other income (please itemize below): $
TOTAL INCOME: $
 
CONTINGENT LIABILITIES
*As endorser, co-maker or guarantor: $
*Other special debt: $
*On leases or contracts: $
*Legal claims: $
*Amount of contested income tax liens: $
 
REAL ESTATE OWNED
*Type of Property:  
*Address:  
*Date Purchased:  
*Original Cost: $ 
*Present Market Value: $ 
*Mortgage Holder:  
*Mortgage Balance: $ 
*Payment per Month/Year: $ 
 
PERSONAL INFORMATION
*Are you an owner, a partner, or an officer in any other venture?
Yes (please explain below) No
*Are you an owner, defendant in any suits or legal actions?
Yes (please explain below) No
*Have you during the 15 year period immediately preceding the date of this application been adjudged a debtor in bankruptcy or reorganized personally or professionally due to insolvency?
Yes (please explain below) No
Completion of this online application constitutes permission for BondsExpress.com and its selected surety companies to obtain consumer information, including personal credit reports of individual applicants as well as owners and officers of business applicants, which may be used to determine bonding eligibility. Such credit reports may also be obtained at the time of any review or renewal, any potential or actual claim, or for any other legitimate purposes as determined by the surety companies in their reasonable discretion. This information is held in strict confidence.

Your order is safe and secure
Please allow 24 hours for your quote. Applications received by noon are processed same day. Additional information may be required. If necessary we will contact you to minimize any delay.