Merchants Test Company Information Company Name: DBA: Address Line 1: Address Line 2: City: State: ZIP: Type of Work: Legal Structure: Select Proprietorship Partnership Corporation LLC Producer Name: Indemnity Details Name: Title: Email: Program Questions Is the business in a New York borough? Has the business ever declared bankruptcy? Has the business ever defaulted on a contract? Has there been a previous surety claim? Has there been a recent lawsuit? Does the business have bonds with another surety? Additional Details: Owner Information Name: Email: Address Line 1: Address Line 2: City: State: ZIP: Ownership Percentage: Marital Status: Select Single Married Divorced SSN: Spouse Information Name: Email: Submit
