Defendant*

Bondsman*

Amount*

Bondsman Phone Number*

Power Number*

Email*

Jail/Jurisdiction*

Incarceration Date*

Charges*

Potential Punishment*

Prior Convictions*

Prior Jail Time*

Facts related to arrest/charges*

When Arrested*
YesNo

Private Lawyer*
YesNo

Retainer Paid to Lawyer*
YesNo

Social Security No.*

Gender*
MaleFemale

U.S. Citizen*
YesNo

Next Court Date*

Expected Duration of Bond*

Defendant's DOB*

Born (City)*

Raised (City)*

Length of residence in current city*

Education/Trade*

How Long?*

Employment*

Length of current employment*

Current Home Address*

Own home?*
YesNo

Living with?

Married?
YesNo

If yes, enter the information below. If no leave it blank.

Spouse's name

Spouse's occupation

Length of marriage

Children?
YesNo

If yes, enter the information below. If no leave it blank.

Child's Name #1

Child's Name #2

Child's Name #3

Child's Name #4

Parents Living?
YesNo

If yes, enter the information below. If no leave it blank.

Father

Mother

Siblings?
YesNo

If yes, enter the information below. If no leave it blank.

Sibling's Name #1

Sibling's Name #2

Sibling's Name #3

Sibling's Name #4

Other Relatives #1

Other Relatives #2

Previously Bailed by Agent?*
YesNo

FTA History

Who paying premium?*

In Full or Over Time?*

Defendant Check-In Required?*
YesNo

GPS Anklet or Other Conditions

Notes

Indemnitor #1

Indemnitor #1 Relationship

Indemnitor #1 Annual Income

Indemnitor #1 Occupation

Indemnitor #2

Indemnitor #2 Relationship

Indemnitor #2 Annual Income

Indemnitor #2 Occupation

Indemnitor #3

Indemnitor #3 Relationship

Indemnitor #3 Annual Income

Indemnitor #3 Occupation

Indemnitor #4

Indemnitor #4 Relationship

Indemnitor #4 Annual Income

Indemnitor #4 Occupation

Indemnitor #5

Indemnitor #5 Relationship

Indemnitor #5 Annual Income

Indemnitor #5 Occupation

Property Location (1)

Owner

FMV

1st Lien

2nd Lien

100% Equity

80% Equity

Completed Bail Bond Application*
YesNo

Completed Indemnity Agreements*
YesNo

Deed of Trust/Mortgage*
YesNo

Evidence of Property Value (Tax Assessment, Appraisal, DataQuick, etc)?*
YesNo

Evidence of Liens (title work, mortgage statement, etc)?*
YesNo