Miscellaneous

Request Types

Instructions

Reminder

Please note that we will need at least 7-14 days for processing. If needed sooner, please indicate on your request form.

Local Number, Line of Business Number, Forms & Self Service

Please use the following downloads to correctly fill in your Local Number, Line of Business Number, and Forms & Self Service.

Help

For assistance, feel free to email RSNew@usi.com, or call 844-265-0017.

Meet Our Team

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License/Permit, Miscellaneous Bonds

Division Number (4 digits) *

Local Number (4 digits) (For a guide, click on the "Local Number" link in the instructions to the left.)

Line of Business Number (3 digits) (For a guide, click on the "Line of Business Number" link in the instructions to the left.) *

Principal Name (Legal Entity Name) (For a guide, click on the "Legal Entity Name" link in the instructions to the left.) *

Obligee / Beneficiary Information

Name *

Street Address *

City *

State *

Zip Code *

Bond Information

Required Effective Date *

Bond Amount *

Description or Type of Bond (Example: Motor Vehicle License, Weighmaster, Notary bond) *

Notary Weighmaster Applicant Name

Electronic Submission Only

Yes

Contact Information

Name *

Email *

Phone Number *

Form Submission Details

If you have attachment(s) to upload, you can upload them here:

Special Instructions

Is the due date of your request within 7 days of request submittal?

Yes

Are you a Republic employee? (Only Republic employees may submit this form.) *

Yes

*Required Fields