New York City Industrial Laundry Delivery Bond

NO UNDERWRITING OR CREDIT CHECK! Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false, incomplete, or misleading information, or conceals information concerning any material fact whereto, commits a fraudulent insurance act, which is a crime punishable by incarceration, and shall also be subject to civil penalties.

CONTACT INFORMATION:

Name *

Email *

Phone Number *

Social Security # *

Bond Information (enter exactly how it should appear on your bond)

Obligee (Owner requiring the bond) *

Obligee Address *

Country

City

State

Zip code

Laundry Name *

Business Address *

City *

State *

Zip *

Business County *

Laundry or Laundry Jobber *

Effective Date *

# of Employees *

Bond Amount *

Special Instructions