Dealer Bond Request - Socal Dealer Training

What license are you applying for?

Used Car Dealer – Retail

Used Car Dealer – Wholesale

New Car Dealer

Your Name

First

Middle

Last

Phone Number

DBA/Company Name (If applicable)

If you have a dba under a company please indicate. For instance XYZ LLC DBA XZY dealer

Company Address

Has the business, or any other owner/applicant: (please check box if it applies)

a. Ever been convicted of a crime?

b. Ever had their business license suspended, revoked or denied?

c. Ever been party to a surety bond claim?

(If any answers are yes, please provide details in the comments section.)

Social Security Number

Ownership Percentage Of Company

The individual named in this request, who is the owner, officer, or related party of the applicant for this surety bond, has requested that this application be submitted to a surety company for the purpose of underwriting — which includes determining eligibility, risk assessment, potential or actual pricing, and other related services. By submitting this request, you authorize NPC Surety Bond and its partners or representatives to verify the information provided and to use your personal credit history as part of the underwriting process. This may include a soft credit check (which does not affect your credit score). A record of this request and your consent will be kept on file.

Yes

I acknowledge and consent to the use of my personal credit history by NPC Surety Bond and its surety partners for underwriting purposes.

Yes