Notary Bond Application Form
SSL Please complete and submit the following form with confidence: Hill & Usher does not sell or otherwise transfer any of its database information to other entities for the purposes of marketing to you.

Daytime Telephone

( )
New Re-Appointment
Month Day Year


Coverages Requested (if known)


Additional Information

Go Back to the Top of the Form.

By submitting this request, you attest to the accuracy and completeness of the information provided. You understand that no coverage is in force until a policy of insurance is approved and issued on your behalf. Hill & Usher will not be held responsible for coverages not available, coverages not requested by you, or limits not sufficient at the time of this submission.

No application will be submitted or bound with the insurance carrier until you have accepted our quotation.

By submitting this request for a quotation, you hereby permit the agency, its employees, owners, and affiliated insurers (HILL & USHER, LLC) to use data contained within your "insurance credit score" as the basis for determining your eligibility for our products where permitted by law.  You understand that an unacceptable "insurance credit score" as deemed by our insurance carrier(s) may result in your ineligibility for coverage.  You agree to hold HILL & USHER, LLC harmless from fault or liability in the event that your "insurance score" is unacceptable to the carrier(s), even if the information contained therein proves inaccurate in any way.
Due to privacy concerns and the proprietary nature of "insurance scores," HILL & USHER, LLC will not know the details of your "insurance score." In compliance with the Fair Credit Reporting Act, you have the right to request information about your "insurance score" or to dispute in writing the results of an unfavorable "insurance score."  Upon request, HILL & USHER, LLC will furnish you with contact information for the relevant credit rating bureau.  Your "insurance credit score" is a combination of your business or personal credit history, loss history, and other factors that may reasonably predict the likelihood of future claims.

If you have Questions/Problems with this form please email the webmaster or call our office at (602) 956-4220 between 8AM and 5PM Monday through Friday, Arizona time.
Have Questions?
Need more information about Hill & Usher or one of our programs? Contact one of our licensed insurance professionals by phone or email for assistance.
These newsletters are published on an as-needed basis to make our customers aware of changes in the Insurance Industry.
"At Hill & Usher, we are developing a website that we hope makes doing business with us simple and straightforward. Please visit us regularly to see how Hill & Usher is working to make your time online with us a quality experience."
Richard B. Usher,
Agency Principal
Hill & Usher
© Hill & Usher, LLC. All Rights Reserved. CA #0C73815
Phone: (602) 956-4220 | Fax: (602) 956-4418