The One Application

User Information

Invalid Input
User already exist
User already exist please login
Invalid Input
Are you an insurance agent?
Invalid Input

Insurance Agency Information

Invalid Input
Invalid Input
Invalid Input - No special characters
Invalid Input
Invalid Input
Invalid Input

Below is the start of your client's information.

Customer Information

Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Have you had a surety claim?
Invalid Input
date format xx/xx/xxxx
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Bond Type - Hover over each for more information
License & Misc. <font color="blue" size="2">(more)</font>
Invalid Input
Performance <font color="blue" size="2">(more)</font>
Invalid Input
Fidelity / Biz Svc <font color="blue" size="2">(more)</font>
Invalid Input
Probate <font color="blue" size="2">(more)</font>
Invalid Input

Owner Info

Invalid Input
Is the company address the same as your home address
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
000-00-0000
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Discribe your credit history?
Invalid Input
Personal Credit - Are you currently, or in the past 5 years:
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input

Consumer Authorization

I authorize Platinum Insurance and Bonds, Inc. / and the Surety and/or Surety broker of their choice to make inquiries as necessary concerning or pertaining to the Owner(s), applicant(s), and third party indemnitor(s) listed in this application financial standing, credit report, character or manner of meeting obligations to verify the accuracy of the statements made and to determine their credit worthiness.
Please click to read FCRA disclosure and Terms of Use
Click here to acknowledge you have read and accept the Consumer Authorization
Invalid Input
Click to add an additional owner
Invalid Input

Bond Information

Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input
Invalid Input