Great Insurance Values.com brought to you by Lakhani Insurance Agency, Inc.

f Great Insurance Values.com brought to you by Lakhani Insurance Agency, Inc.

Lakhani Insurance Agency, Inc.

Individuals, Families & Groups
Life Insurance
Health Insurance
Group Insurance
Dental Insurance
Medicare Supplement
Disability Income
Long-Term Care
Retirement Accounts

Business Owners, Self-Employed
General Liability
Commercial / Business Ins.
Commercial Auto Insurance
Commercial Property
Umbrella Insurance
Employment Practices
Lessor's Risk
Workers Comp

Medical & Dental Professionals
Medical Malpractice

Garage Liability
Auto Dealers
Auto Repair / Body Shops

Professional Liability
Engineers
Attorneys

Surety Bonds
Auto Dealer Bond
Construction Bond
Contract Bond
Performance Bond
Subdivision Bond
Contractor License Bond
Insurance Brokers Bond
License & Permit Bond
Mortgage Broker Bond
Payment Bond
Probate Bond
Sales Tax Bond
Miscellaneous Bonds

Sales Tax Bond

Sales tax bonds guarantee that a business will pay sales tax to the state or local government. Failure to pay collected funds or incorrect reporting can result in a bond claim. Unlike most financial guarantee bonds, the sales tax bond requires no collateral by bonding companies.

Name:	(required)
Email:	(required)
Phone:
Preferred contact:	phone email

Business Name:
Business Address:
Owner's Name:
Percentage of Ownership:
Years in Business:
Years Experience in Field:

Entity Requesting Bond:
Bond Amount:

How is your credit?
Do you own real estate?	yes no
Annual Receipts / Sales:	(estimated)

Has the applicant, stockholder or indemnitor ever:

been cancelled by a surety?	yes no
had a bond claim?	yes no
declared bankruptcy?	yes no
had or have prior or pending tax liens?	yes no
had or have prior or pending lawsuits?	yes no
been convicted of a felony?	yes no