Janitorial/Dishonesty Bond: Main Street AmericaBusiness NameBusiness AddressPhone NumberEmail Address Describe Product or ServiceNumber of EmployeesBond Amount RequestedDate Requested DD slash MM slash YYYY Have you suffered any dishonesty losses in the past 6 years? Yes NoDid you have prior coverage in the last 6 years? Yes NoHas any coverage been canceled in the past 6 years? Yes NoDo you act as a money or securities handler or messenger? Yes NoDo you act as a Bookkeeper, Accountant, or assist clients with handling finances? Yes No
