US Customs Bond Quote

1 Agent Information

Are you an insurance agent completing this application on behalf of a client?*

Yes

Agency Name*

Agent Name*

Agent Email*

Phone Number*

Note: If you are currently registered as an agent with BondsExpress.com we will mail a commission check to you within one month of your surety bond purchase. If an updated E&O policy and/or business license is needed, one of our agents will contact you right away. Thank you for your continued partnership.

2 bond information

Type of Shipment*

Continuous

Single Entry

Enter Bond Amount*

Select Activity Type*

3 Principal information

Importer Name/ Company Name*

Include any DIV/ DBA/ AKA Name (The Rock Inc DBA Dwayne Enterprises)

Business Type*

Individual

Partnership

Corporation

LLC/ LLP

Business Physical Address*

Street Address Address Line 2 City State ZIP Code

Same as Mailing Address?*

Yes

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Email*

IRS # / SSN / Customs Assigned #*

Business Financial Statements Required: In order for this bond to be written, a copy of the business's Balance Sheet and Profit & Loss statement must be submitted for review with this application.

If you do not currently have a copy of these on hand or cannot upload the documents here, a representative will reach out to you via email following the completion of this form in order to obtain them. If you have any questions regarding this, please contact us at 1-800-836-4818.

File

Drop files here or

Max. file size: 50 MB.

4 Questionnaire

Is this an additional bond requested by U.S. Customs?*

Yes

Is a current custom bond on file?*

Yes

Is your company CTPAT certified?*

Yes

Is this bond subject to Antidumping or Countervailing duty?*

Yes

How does your company file Importer Security Filings (ISF)?*

Self

CHB

N/A

How does your company pay U.S. Customs duty?*

Check

ACH

Statement

N/A

Has your company been assessed post entry duty adjustments?*

Yes

Number of bills?*

Dollar Amount:*

Explanation:*

Has your company received U.S. Customs “Notice of Penalty or Liquidated Damages” demands?*

Yes

Number received in the last 12 months:*

Explanation:*

4.1 For Activity 1: Importer or Broker 19 §113.62

Type of Imported Goods*

For Activity 1: Importer or Broker 19 §113.62

Enter Top Three Based on Dollar Volume

Please Enter Requested information from Highest to Lowest on the lines below

HTS Product Code*

Country of Origin*

Product Description*

HTS Product Code

Country of Origin

Product Description

HTS Product Code

Country of Origin

Product Description

Enter Projected Dollar Amount

Please Answer all sections below with the Dollar Import Volume from the Last Twelve Months

Free On Board (FOB) Value*

Estimated Duties/ Taxes/ Fees*

IR Taxes*

Number of Customs Entries*

Enter Projected Dollar Amount

Please Answer all sections below with the Estimated Dollar Import Volume for the Next Twelve Months

Free On Board (FOB) Value*

Estimated Duties/ Taxes/ Fees*

IR TAXES*

Number of Customs Entries*

4.1 For Activity 3: International Carrier Bonds §113.64

Activities to Be Conducted*

List Primary Destination(s)*

Does Your Company Transport Goods via Air Transportation?*

Yes

Number of Planes and the Model*

Largest Seating Capacity*

4.1 For Activity 11: AIRPORT SECURITY BOND Pt 113 App A

List Airport(s)*

Add more entry lines by clicking the "+" symbol at the end of the line.

5 Enter owner information

Number of Owners*

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Phone Number:*

Married

Percentage of Ownership*

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number*

Married

Percentage of Ownership

Enter additional owner information

Additional owner Information

Follow-Up Notice: Upon completion of this application, an underwriter will reach out to you via email to obtain a copy of your company's business financial statements. No bonds can be quoted without these documents.

Credit Inquiry Notice: If needed to facilitate the underwriting review process and obtain the best possible rate for your surety bond, BondsExpress.com may pull a soft credit report. This credit inquiry does not affect your credit in any way whatsoever. If you have any questions regarding this type of credit inquiry, please contact us.

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