Judicial Bond Application Step 1 of 5 20% HiddenIf this application is part of a campaign, enter the name below: What type of Judicial Bond do you need?* Do you require a Supersedeas, Appeal, Injunction, Replevin, Cost, Attachment, Garnishment, TRO or another type of Judicial Bond?What state do you need the bond for?*Select the state requiring the bondAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPlease enter the bond amount you require.*Select the bond effective date.* MM slash DD slash YYYY What is the name of the court?* What is your full name?* What is the name to appear on the bond? (If different). What is your full address?*Enter your full address, including your street, city, state and zip code.What is your billing address? (If different).Are you applying for this bond as an individual or company?* Individual Company What type of business?* Partnership C-Corp S-Corp LLC/LLP Other Please enter type of business.* What is the company's business class?* How many years has the company been in business?*What is the business Tax ID Number?* What is the name of your employer?* What is your annual income?*What is your Social Security Number?* You're on a secure network. We need your SS# to pull credit. This is a soft pull that does not adversely affect your credit score.What is your phone number?*What is your fax number?What is your email address?* Enter Email Confirm Email What is your Date of Birth?* MM slash DD slash YYYY Do you have any other surety bonds in force?* Yes No Has another surety company declined to write this or any previous bond?* Yes No Have you ever had a bond involuntarily terminated or canceled?* Yes No Has there ever been a claim or legal action against any bond executed on your behalf?* Yes No Do you or your companies have any pending lawsuits, unsatisfied judgments or liens?* Yes No Have you or any of your companies declared bankruptcy or become insolvent?* Yes No Have you or any of your companies been the subject of any legal or administrative proceedings resulting in disciplinary action?* Yes No Have you ever been convicted of a felony?* Yes No Please explain for any of the previous questions you answered "yes".* What is your attorney's name, firm name, full address, email and phone number?*Is your bond for a receivership, trustee in bankruptcy or assignee for the benefit of creditors?* Yes No Who is the debtor?* What's the debtor's full address?*Please include street address, city, state and zip code.What type of action is taking place?* Liquidation Reorganization Receiver of Rents Other Please explain the action.*Do you carry fidelity coverage?* Yes No Do you carry Professional Liability or E&O coverage?* Yes No What is the amount of Professional Liability or E&O coverage and who is the carrier?* What is the amount of the claim/judgment?*What type of action?* What is your case number?* What is your court jurisdiction?* Please provide a summary of the action.*Does this case involve a domestic dispute?* Yes No Please explain the domestic dispute.*Were you referred to us by Arthur J. Gallagher & Co.?* Yes No Do you agree to the following terms?*I acknowledge and authorize the procurement and use of a credit report for the individuals/businesses listed above. If submitted by a third party, you agree that you have the authorization of the applicant. I agree Please upload any court documents / surety documents that you have. Drop files here or Select files Max. file size: 256 MB, Max. files: 6. HiddenWhat is today's date?* MM slash DD slash YYYY