SOUTH COAST SURETY

California Contractor's License Bond
Roofers and Swimming Pool Contractors Online Application Form
Bond Amount: $10,000

Please Complete all fields (Application may be rejected if all information is not provided)

A credit check will be required for this bond.
You will be notified if the Applied for Standard Rates are not approved, prior to any bond issuance or payment.

Please Select Company Type: Individual Partnership Corporation Limited Liability Company Limited Liability  Corporation RME /RMO 

      Standard Rates For Roofer / Swimming Pool Contractor  $10,000 Bond
                      1 yr - $ 127.00  2 yrs - $227.00 
     Sub-Standard Rate For Roofer $10,000 Bond
                               1 yr - 500.00  2 yrs - $967.00 
      Sub-Average Rate For Swimming Pool Contractor  $10,000 Bond
                             1 yr - $ 400.00  2 yrs - $740.00 
      Sub-Standard Rate For Swimming Pool Contractor  $10,000 Bond
                             1 yr - $ 1000.00  
Contractor's License Number          Contractor License Class  

If you have a license number with the Contractor's State License Board enter it here.  If you are applying for a new license and do not have a license number you must enter your Application Fee Number.

Name to appear on bond Business Tax ID#

This name must match the name that is or will be on your contractor's license.

 
Name of person who will sign for this bond     Percent Owned 

If the name appearing on the bond is a business or corporation, this must be the name of the owner or president.  If the name appearing on the bond is an individual, then the name is the same. If multiple owners, PLEASE HAVE ADDITIONAL OWNERS COMPLETE ADDED APPLICANTS BELOW or fax completed print application Contractor License Bond App

  Same as name appearing on bond.  

Please Indicate:   Marital Status  Single Married  Own Residential Real Estate? Yes No     Net Worth

          Social Security Number     Number of Years in Business?     Number of Years Licensed?
                                                                        

Requested effective date 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 2008 2009 2010 2011 2012 2013      County

Leave this blank if you wish your bond to become effective the same day it is issued.  You may request to have your bond become effective at any date in the future, or up to 30 days in the past.

Home Address

Address Line 1
Address Line 2
City	State
Zip code	Phone No.

Business Mailing Address

Same as home address.

South Coast Surety will mail the bond to this address.

Address Line 1
Address Line 2
City
State
Zip code

Business phone number                       Fax number                           E-mail address 

Area	Phone Number	Extension                   Area    Phone Number

Payment Information
We recommend that you enter your credit card information below to expedite receiving your bond. *
We will not bill you until the bond is approved and issued. 
You may leave this blank and upon approval we will contact you with a premium confirmation and information on payment options.
We accept: Visa or MasterCard.*
*There is a 6% fee added for all credit card transactions.

Credit Card Number	3 Digit Security  Code
Expiration Date	123456789101112 / 200820092010 2011 2012 2013
Name appearing on credit card

Credit Card Billing Address

Same as Mailing address    Same as Home address.

Address Line 1
Address Line 2
City
State
Zip code

If RME / RMO (BOND OF QUALIFYING INDIVIDUAL) COMPLETE THE FOLLOWING:
Name of Firm on License
Company Address
City / State/ Zip
Company Phone   Company Fax

ADDED APPLICANTS

Name       Percent Owned        Marital Status  Single Married 
  Own Residential Real Estate? Yes No     Net Worth     Social Security Number 

Address Line 1
Address Line 2
City	State
Zip code	Phone No.

Name     Percent Owned     Marital Status  Single Married 
Own Residential Real Estate? Yes No     Net Worth            Social Security Number 

Address Line 1
Address Line 2
City	State
Zip code	Phone No.
Referred By	Please Select Referral Source Search Engine Personal Referral Yellow Pages Radio Direct Mail Other- Enter Below

 Premiums for On-Line Applications are fully earned upon approval and payment.