MERCHANTS BONDING COMPANY (MUTUAL) * P.O. BOX 14498 * DES MOINES, IOWA 50306-3498
PHONE: (800)678-8171 * FAX: (515)243-3854

For more bond information and a Premium Chart, please click here.
There is a One-time Fee of $100 in Addition to the Rates Shown

THEFT GUARD APPLICATION FOR BOND
Applicant Phone Number
Physical Address
Type of Business(Purpose and Function)
Any employee dishonesty losses in the last 5 years? Yes No   If yes, please list all details separately below.
Amount of coverage requested: $5,000   $10,000   $25,000   $50,000   $100,000*   Other:   $
  1 Year Bond     3 Year Bond (reduced rate of 2.85 x annual premium) Effective Date of Bond:
 Total number of individuals covered: (Include full and part-time, owners/officers, volunteers, and independent contractors):
 Are owners/officers to be covered? Yes   No If yes, how many of total number are owners/officers:
 Are volunteers to be covered? Yes   No If yes, how many of total number are volunteers:
 Are independent contractors to be covered? Yes   No If yes, how many of total number are ind. contractors:

THEFT GUARD
STANDARD
Businesses with more exposure such as cafes, gas stations, retail stores, businesses with salespeople, non-profit social organizations, non-profit businesses with employees covered, and courier services (except those handling cash and negotiable instruments).

This bond contains a conviction clause. The employee must be convicted before coverage will apply.

THEFT GUARD
JANITORIAL
SERVICES

 This bond contains a conviction clause. The employee must be convicted before coverage will apply.

THEFT GUARD
PRO

*Limits up to
$50,000 only
Professional businesses such as accountants, architects, physicians, dentists, insurance agents, and attorneys.
Also includes non-profit businesses/organizations with no employees covered.
(Officers are not covered under this bond, unless the Insured is a corporation, and the officers are in the regular service of the Insured and compensated by salary, wages, etc.)
For limits over $25,000, please complete the Control Questions below.

Control
Questions 		 Will countersignature of checks be required? Yes   No If yes, by whom?
 How often will a complete audit be made? When was last audit made?
 By whom was audit made?       Certified Public Accountant           Independent Accountant           Internal
 Are bank accounts reconciled by someone not authorized to deposit or withdraw therefrom?       Yes   No

Any person who knowingly provides false or misleading information to an insurer for the purpose of obtaining an insurance policy/bond or receiving payment on a claim is commiting a crime. Penalties will be enforced in accordance with state law.

Completed by: (Required) Date
Email Address

 Agency Name
 Surety Advisors, LLC
 Agency Code
 08574
 Address
 800 Bering Drive Ste 310
 City
 Houston
 State
 Texas
 Zip
 77057
 
 2130

FID 0059 (1/16)

Please press the "Submit" button below to send this application electronically,

   

or else "Print" and mail or fax the completed Application to Surety Advisors, LLC.