Application for U.S. Custom Continuous Import Bond
(Type-it-in Only, NO handwriting)
Principal / President / VP (Applicant):
Company Name: (Print only)
Complete Business Address, City, State and Zip (No PO. Box)
Phone # Fax #
What date you want your New bond to be Effective: ( Month / Date / Year )
(This is subject to change at the discretion of US Customs)
How many year(s) do you want to Purchase the Bond 1 Year for $357 2 Years for $658.31
(Above cost are Base on the $50,000 Bond which Cover up-to $500,000 of Duty and Tax to U.S. Customs, if you are applying for more then $50,000 Bond please let us know. Also, above cost are subject to approval by U.S. Custom and with your good credit)
IRS # / EIN # / Tax id: Number of Years in Business:
State Business Register (for LLC only): State of Incorporated:
Individual Sole Proprietorship Corporation LLC Partnership (Need Copy of Partnership Agreement)
S.S.N (Only if you are applying under your personal name)
Do you have currently a Bond: Yes No
If you have a bond with other bond company & if you are Re-Newing the Bond with us, also fill-out a: (click here / Hold the Ctrl & click)
General Description of Merchandise you are importing:
Countries Importing From:
Last Calendar Year (Must Answer) Next Calendar Year (Must Answer
Estimated Imported Total Values: (Must Answer)
Estimated Imported Total Duties Paid: (Must Answer)
ADD / Anti Dumping Duties (Must Answer) : Yes No
ADD Case # (if Yes): ADD Tariff Code (if Yes)
From 100% of import goods, Estimated the total ADD Percentage of goods being Imported for Next Calendar Year (if Yes)
I/We/Applicant certified that the factual information contained in this application is true and accurate and was provided based upon the best available information at the time of this application. Further, I/We/Applicant agree that when this application is Signed and when Bond Application submitted and issued, I/We/Applicant will then be fully and contractually responsible for the full payment amount as confirmed and agreed herein. When applicant bond number/certificate is issue & if applicant/reseller refuses to pay within ten days, then bond provider has a right to cancel/terminate applicant bond anytime I/We/Applicant also understands that invoices and correspondence will be communicated thru the email address given herein. This bond application encompasses the terms, conditions and languages as specified in CBP-5291 (Power of Attorney Form) and satisfy the requirements of 19 CFR 149.5(c) and shall be retained by this bond provider for as long as applicants continues to use and operate the bond acquired thru this bond provider. I/We/Applicant acknowledges that when payment is made in-full there is/will be no pro-rate or refunds for any bond termination after activation. If you are applying for more then $50,000 Bond please let us know. Also, all Bond(S) are subject to approval by U.S. Custom and with your good credit. Minimum Premium is $357 for One year & $658.31 for 2 years
Signature (I/We/Applicant): ______Date:
(Before signing, Please double check, if answer is blank, application will be Reject it.) ( mm / dd / yyyy )