FREIGHT BROKER BOND applicationadmin2021-04-25T17:31:07-05:00 Step 1 of 2 50% Applicant Full Legal Name (Company Legal Name)* Type of Company* Sole Ownership Partnership Corporation LLC Legal Name and Title of person who will sign the bond* Business Address* Phone* Email* Country or State of Incorporation* IRS #* MC #* Effective Date (Desired) Has application for this bond been declined by another company? If yes, state particulars If prior Surety, give name and reason for change Has the business or any other principal involved:a. Had any lawsuits or judgments against them?* Yes No b. Had any tax liens or debts against them?* Yes No c. Ever failed in business or declared Bankruptcy?* Yes No d. Ever been convicted of a felony?* Yes No e. Had any past due child support?* Yes No f. Ever had their license suspended, revoked or denied?* Yes No g. Ever been a party to a surety bond claim?* Yes No If any answer is yes, attach a detailed statement.Does the company carry Cargo Liability Insurance* Yes No Does the company operate any other unincorporated branch offices in the United States?* Yes No Does the company maintain written records of the type/quantity of goods being shipped prior to transport?* Yes No If Yes, Date of Expiration? Name / Title* Social Security #:* Spouse Social Security #: % ownership:* # years owned business:* # years ocean cargo/freight experience:* Home Address:* Balance of Mortgage:* Fair market value of home:* Name / Title Social Security #: Spouse Social Security #: % ownership: # years owned business: # years ocean cargo/freight experience: Home Address: Balance of Mortgage: Fair market value of home: Name / Title Social Security #: Spouse Social Security #: % ownership: # years owned business: # years ocean cargo/freight experience: Home Address: Balance of Mortgage: Fair market value of home:
