Bond Form

Bond Form

Cancelled

Job Description

I need a bond form created using anything but Java. I already have the template which is attached. The template need to be changed to html or html 5.

Below is what each page should be configured
MVD Bond Form
Steps 1. Principal Informaiton 2. Owners Information 3. Bond Information 4. Quote
Below are each page with fields and description on functionality.

Page #1 - Company Information
Company Name:
Entity Type: Drop Down (individual, partnership, sole properietorship, Corporation ,LLC, Sub S Corporation)
Number of Owners: Drop down (1,2,3,4,5)
Mailing Address
City
State
Zipcode
Business Phone #
Personal Phone #
Fax #
Nature of Business – Drop Down ( Wholesale Dealer , Retail Dealer)
Havy any claims every been made agaisnt bonds you post is the past ? Radio Button (YES, NO)
Has Principal or have any of its owners, partners, stockholders ever fialed in business, compromised with creditors, been subjects of bankruptcy or surety claims proceedings ? Radio Button ( YES, NO)

NEXT BUTTON TO GO TO PAGE 2

Page #2 Princpal Owners Information
Owners Info
First Name:
Last Name:
Email:
Social Security Number: Text Box format (XXX-XX-XXXX)
Title:
Ownership %: (text field numbers only 1-100)
Years Experience:
Martial Status: (Single, Married, Divorced, Widowed ) If client selects ( Single, Divorced, Widowed) Gray out and disable Spouse Field.
Spouses Info:
Spouse First Name
Spouse Last Name:
Spouse Social Security #:
Residence Section
Residence Information
Residence Address:
City
State
Zipcode
Phone #


Page #3 Secondary Owners Information
Owners Info
First Name:
Last Name:
Social Security Number: Text Box format (XXX-XX-XXXX)
Title:
Ownership %: (text field numbers only 1-100)
Years Experience:
Martial Status: (Single, Married, Divorced, Widowed ) If client selects ( Single, Divorced, Widowed) Gray out and disable Spouse Field.
Spouses Info:
Spouse First Name
Spouse Last Name:
Spouse Social Security #:
Residence Section
Residence Information
Residence Address:
City
State
Zipcode
Phone #
Page #4 Third Owners Information
Owners Info
First Name:
Last Name:
Social Security Number: Text Box format (XXX-XX-XXXX)
Title:
Ownership %: (text field numbers only 1-100)
Years Experience:
Martial Status: (Single, Married, Divorced, Widowed ) If client selects ( Single, Divorced, Widowed) Gray out and disable Spouse Field.
Spouses Info:
Spouse First Name
Spouse Last Name:
Spouse Social Security #:
Residence Section
Residence Information
Residence Address:
City
State
Zipcode
Phone #

Page #5 Fourth Owners Information
Owners Info
First Name:
Last Name:
Social Security Number: Text Box format (XXX-XX-XXXX)
Title:
Ownership %: (text field numbers only 1-100)
Years Experience:
Martial Status: (Single, Married, Divorced, Widowed ) If client selects ( Single, Divorced, Widowed) Gray out and disable Spouse Field.
Spouses Info:
Spouse First Name
Spouse Last Name:
Spouse Social Security #:
Residence Section
Residence Information
Residence Address:
City
State
Zipcode
Phone #




Page #6 Bond Information
(Display info below on this page)
Bond Amount: (if cleint selected Wholesaler on page #1 display $10,000)
(If client selected Retialer on page #1 Display $50,000)
Obligee: State of California Department of Motor Vehicles
Licensing Operations Division
Occupational Licensing Branch

Address: P.O Box 932342, MS:L224
City : Sacramento
State : CA
Zipcode: 94232

Button GET QUOTE . (go to thank you page)

LAST PAGE SHOULD BE A THANK YOU PAGE.
Princpal First Name,
Thank you for applying for your motor vehicle dealer bond. Your information has been submitted to our underwriting deparment. You will receive an email with your permium indication within 24 to 48 hours. If you have any quesiton or concerns please contact our office at 877-969-4747.

Thank you for your business,
Bond Team
Green Peak Insurance Solutions


PLEASE REVIEW THE WORD DOCUMENT AND ALSO THE TEMPLATE. We will not tolerate any excuses or no responses. You must be able to meet our timeline for December 31st. PLEASE DO NOT APPLY IF YOU CANNOT MEET OUR TIME CONSTRAINT.