Broker Application

Terms of Service

You must answer the following questions accurately. I understand false statements may result in forfeiture of benefits and possible prosecution by the US Attorney-General - (Any person who knowingly and with the intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing false, or misleading information is guilty of a felony of the third degree. The quote you are about to receive is only a conditional offer and is subject to change based on a multitude of considerations. The quote may include a broker fee. Any possible broker fees are part of the quote you are about to receive. There is no cost should you decline the offer, obtaining a quote is 100% free. If your bond is cancelled mid term, the fees and all premiums are fully earned, and are not refundable. In addition, fee may earn interest. This undeclared income is non-refundable and fully earned as well as any fees charged. Bryant Surety Bonds, Inc. reserves the right to change the terms of this agreement at anytime without notice. This agreement shall serve as the writing required pursuant to the rules set forth by your Department of Insurance.
To help protect against fraud your Internet IP address will be recorded.

IP Address: