EmailMe Form - Principal Registration

Agent

First Last

Bail Bondsmen

Court and County

Next Court Date

MM / DD / YYYY

Court Room and Time

Docket Case Number

Use a commas to separate case numbers.

Bond Out Date

MM / DD / YYYY

Release date from custody.

Bond Number

Bond Amount

Total sum placed for collateral with the State.

Bond Fee

Bail Amount

Bond Deposit

Down Payment

I undersigned, do hereby apply to you to act as my bail bondsman in the applicable county where I am charged with the offenses of:

List charge(s)

Defendant Name

First Last

Principal

Defendant Date of Birth

MM / DD / YYYY

Defendant Place of Birth

City and State

Defendant Race

Defendant Gender

Male

Female

General Description

Defendant height, weight, eye and hair color.

Defendant Social Security Number

Defendant State Issued ID

Upload a clear picture of the card.

Defendant Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Currently resides.

Subdivision & Apartment Number

Gate Code

Do you rent or own?

Rent / Lease

Own

How long have you lived here?

Defendant Phone Number

### - ### - ####

Defendant Email

Previous Residential Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Defendants Employer

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Defendants Position

What's your job title?

Defendants Salary

What are your annual earnings?

Defendants Tenure

How long have you been working there?

Defendants Supervisor

First Last

Supervisor Phone Number

### - ### - ####

Defendant Work Shift

Morning

Noon

Night

Defendant Vehicle Description

Year, make, model, color and car tag.

Name of Defendants First Born Child

First Last

Childs Phone Number

### - ### - ####

Name of Defendants Significant Other

First Last

Significant Other Phone Number

### - ### - ####

Name of Defendants Closest Relative

First Last

Closest Relative Phone Number

### - ### - ####

Name of Defendants Best Friend

First Last

Best Friends Phone Number

### - ### - ####

Consent Release Form

I hereby authorize the bonding company and/ or its Agent(s) to receive any criminal history record information pertaining to me which may be in the files of any foreign country. I further authorize the agent(s) to receive any Department of Motor Vehicle Records, Department of Labor, Social Security Administration or Homeowner Lease/ Purchase, Employer, Credit History, Banks/ Savings & Loan, finance company, Attorney/ Legal Service, Scholastic and any other information/ records pertaining to me which may be in the files of any individual, company, and Federal, State, Local or foreign government agencies. This includes, but is not limited to, all federal and state privacy acts, such as Family Education Right and Privacy Act. I understand that all information, obtained will be used for criminal investigation against myself in the event I do not appear in court and agree that this consent shall be valid until such time as my case has been disposed. In addition to authorizing the bondsmen and / or its Agent(s) to receive said information, any entities releasing said information/ records to the bondsmen shall be held harmless from all liabilities by myself.