courtbond

Court Bond Form

Court Bonds Including: Appeal • Attachments Stay Pending Appeal • Supersedeas • Undertaking Bond • Certiorari • Cost • Discharge • Discharge Injunction • Lien • Mechanic Lien • Stay of Execution • Injunction • Replevin

Call us at 800-921-1008 with any questions

Type of Bond

Amount of Bond

Effective Date

Business Data

Company name (as it appears on bond)

Business Address

State

Occupation or Business

How long so engaged?

Mechanic’s Lien Data

Name of Claimant (Obligee)

Address of Claimant

State

Nature of dispute

Applicant Data

ApplicantName

Social Security Number

Date of Birth

Residence Address

State

Phone Number

Email

Married Single

Spouse Name

Spouse Social Security Number

Spouse Date of Birth

Previous Surety?

Yes No

Is there an Additional Owner?

Yes No

Additional Owner #1

Social Security Number

Date of Birth

Residence Address

State

Phone Number

Email

Married Single

Spouse Name

Spouse Social Security Number

Spouse Date of Birth

Is there an Additional Owner?

Yes No

Additional Owner #2

Social Security Number

Date of Birth

Residence Address

State

Phone Number

Email

Married Single

Spouse Name

Spouse Social Security Number

Spouse Date of Birth

Is there an Additional Owner?

Yes No

Additional Owner #3

Social Security Number

Date of Birth

Residence Address

State

Phone Number

Email

Married Single

Spouse Name

Spouse Social Security Number

Spouse Date of Birth

Financial Statement

Statement of assets and liabilities as of (Date)

Check one

Business financial statement Personal financial statement

Assets

Cash (Total)

Bank Name

Stocks

Bonds

Notes Receivable

Accounts Receivable

Merchandise or Material in Stock

Real Estate (Homestead) A

Real Estate (Investment) B

Furniture and Fixtures

Other Assets

TOTAL ASSETS

Liabilities

LiabilitiesAccounts Payable

Taxes Due - Gas

Taxes Due & Accrued - Other

Notes Payable to Bank

Notes Payable - Small Business Administration Loan

Notes Payable to Others

Owed to whom?

Mortgage on Real Estate (Homestead) A

Mortgage on Real Estate (Investment) B

Alimony, Child Support

Other Liabilities

TOTAL LIABILITIES

Capital Stock (Paid in)

NET WORTH OR SURPLUS

TOTAL Liabilities and Net Worth

Gross Sales 2 Years Ago

Gross Sales Last Year

Net Income 2 Years Ago

Net Income Last Year

In whose name is the title of real estate?

Have you pledged any of the above assets as collateral for loans?

Are you surety or endorser upon any bond, note or other obligation, not included in your liabilities above?

Yes No

Name Of Court

Location of Court

Name of Attorney

Attorney Address

If an Injuntion or Restraining Order Bond, does applicant anticipate a foreclosure or collection action against him/her?

Yes No

If so, submit for underwriting

Secure upload of relevant Court documents below: (ie. Court Order/Petitions)
PDF files preferred

FILE UPLOAD #1

FILE UPLOAD #2

FILE UPLOAD #3

Additional Information & Comments

The undersigned hereby certifies that the list of assets and liabilities given herein is a true and correct statement of the financial condition on the date given above and that all statements made are correct, that the undersigned has never caused his surety loss, and that the depositories are hereby authorized to confirm any inquiry made by WESTERN SURETY COMPANY or its representatives as to any statement made herein relative to moneys on deposit, or loans made. The undersigned authorizes WESTERN SURETY COMPANY to verify this information and to obtain additional information from any source.