info@dickinsononline.com

(208) 773-0504
609 North Syringa Street, Post Falls, Idaho 83854

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Washington Contractor’s License Bond Application

Step 1 of 4

25%

Personal Information
Name*
First Name Last Name
Phone Number*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Bank Name
Bank Address
Bank Street Address Bank City Bank - State Bank Zip Code
Driver's License Number*

Additional Owner, Partner or Member
Name
First Name Last Name
Phone Number
Email
Address
Home Address - Street Home Address - Street 2 Home Address - City Home Address - State Home Address - Zip Code
Driver's License Number

Business Information
Name of Business (Exactly as it is to appear on the Bond)*
Form of Ownership
Business Address*
Business Address - Street 1 Business Address - Street 2 Business Address - City Business Address State Business Address - Zip Code
Business Phone Number*
Date Business Started*
MM slash DD slash YYYY

Bond Information
Type of Bond and Premium Desired. All Terms 1 Year.*
- General - $12,000 premium $275
- Specialty - $6,000 premium $200
- Electrical - $4,000 premium $150
1. If currently or previously bonded, are there any open or paid claims against any bonds?*
- Yes
- No
2. Do you have any accounts placed for collection, unpaid judgements, liens, or past due payables against you?*
- Yes
- No
3. Have you had a bankruptcy, business or personal, in the last ten (10) years?*
- Yes
- No
4. Is this a Disciplinary Bond?*
- Yes
- No

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Please note, this is a request only. One of our agents will contact you to confirm the information you have provided.

Insurance Coverage can not be bound online or over the phone.

Get in touch with us by phone, email, text, or social media!

The protection you need, at a price you can afford.

Our Hours

Monday – Friday: 8AM – 5PM
Closed Saturday & Sunday

Visit Us

609 N Syringa St
Post Falls, ID 83854

Contact Us

(208) 773-0504
info@dickinsononline.com

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