麒麟保險 / Retail Laundry Bond
3808 Union St Suite 2I Flushing NY 11354 | Tel: 718-886-7070 | info@CenturyMax.com | www.CenturyMax.com

Bond Amount $500, 2 Years Term, $75 Premium
Effective Date 1/1/2020 to 12/31/2021
Insurance Company Name: Merchants Bonding Company
洗衣店名字 / Name *
Enter the exact name on the Bond
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DBA
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Email Address
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Phone Number *
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Address *
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Address 2
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City *
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State
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Zip *
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Bill Address same as Principal Address? *
附加说明 / Additional Note
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