Bond Request Form

Please choose if you are an employer/company or a referral agency and would like to initiate a bond request and the Virginia Bonding Coordinator (V.B.C.) will take care of the rest. You will receive an email confirmation with a Request ID that you should refer to throughout the process. Within two business days, you will be contacted to finalize the bond request.

On the day of contact, you will receive a bond letter confirmation, via email, from the V.B.C to acknowledge that the bond was issued for your employee. Next, you will receive the bond insurance policy for your records through the United States Postal Services. This will normally take about 15 business days for you to receive the bond insurance policy documentation. If you have any questions, please contact the V.B.C.

Are you a potential Employer/Company or are you a Referral Agency?

Employer/Company

Referral Agency

Bond Request as a Referral Agency

Required Information*

Referral Agency Information

This is the public service agency referring a participant for a bond.

Agency Name*
Agency Address Line 1* Agency Address Line 2
Agency City* Agency State* Agency Zip*

Agency Contact

This is the person who will be contacted by the Virginia Board Coordinator for more information.

Agency Contact First Name* Agency Contact Last Name*
Agency Contact Work Title* Agency Contact Work Email*
Agency Phone Number* Ext.

Agency's Employer/Company Contact

The employer is the company that is requesting a bond for an employee.

Company Name*
Company Contact First Name* Company Contact Last Name*
Company Contact Work Phone* Ext. Company Contact Work Email*

Bondee Information

Bondee First Name* Bondee Middle Initial Bondee Last Name*
Future Bond Effective Date* Agency Bond Effective Date Additional Information (Do not include any personal information in message.)

Callback Date & Time

Please choose three dates and times that the Virginia Bond Coordinator can contact you to gather additional required information in order to complete the bond process.

#1 Date* Time*

#2 Date* Time*

#3 Date* Time*

Kia Parson,

Virginia Bonding Program Coordinator

Address

Virginia Department of Corrections
Virginia Bonding Program

P.O. Box 26963
Richmond, VA 23261

virginia.bondingprogram@vadoc.virginia.gov

Main Office

(804) 887-8262

Bond Request as an Employer

Employer/Company Information

Employer/Company Contact