Step 1 of 7 14% LARGE BOND APPROVAL FORM ENTRY Please fill out the following form and submit for approval. If you do not receive a telephone call reply to your submission within fifteen minutes, please contact us immediately by telephone. DEFENDANT*BONDSMAN*AMOUNT*ex (9999.99)BONDSMAN PHONE #*###-###-####POWER #* Jail/Jurisdiction:*Incarceration Date:* Date Format: MM slash DD slash YYYY Charges:*Potential Punishment:*Prior Convictions:*Prior Jail Time:*Facts related to arrest/charges:*On Parole/ProbationWhen arrested:* Yes No Private Lawyer:* Yes No Retainer Paid to Lawyer:* Yes No Social Security No.*Gender:* M F U.S. Citizen* Yes No Next Court Date:* Date Format: MM slash DD slash YYYY Expected Duration of Bond:* Defendant DetailsDefendant's DOB:* Date Format: MM slash DD slash YYYY Born (city):*Raised (city):*Length of residence in current city:*Education/Trade:*How Long?*Employment:*Length of current employment:*Current Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Own home?* Yes No Living with?Married?Select OneYesNoSpouse's name:Spouse's occupation:Length of marriage:Children?Select OneYesNoChild's Name #1 First Last Child's Name #2 First Last Child's Name #3 First Last Child's Name #4 First Last Parents Living?Select OneYesNoFather First Last Mother First Last Siblings?Select OneYesNoSibling #1 First Last Sibling #2 First Last Sibling #3 First Last Sibling #4 First Last Other Relatives #1 First Last Other Relatives #2 First Last Previously Bailed by Agent?*Select OneYesNoFTA History:Who paying premium?*In Full or Over Time?*Defendant Check-In Required?* Yes No GPS Anklet or Other Conditions:NOTES INDEMNITORSIndemnitor #1 First Last Indemnitor #1 relationshipIndemnitor #1 Annual IncomeIndemnitor 1 OccupationIndemnitor #2 First Last Indemnitor #2 relationshipIndemnitor #2 Annual IncomeIndemnitor #2 OccupationIndemnitor #3 First Last Indemnitor #3 relationshipIndemnitor #3 Annual IncomeIndemnitor #3 OccupationIndemnitor #4 First Last Indemnitor #4 relationshipIndemnitor #4 Annual IncomeIndemnitor #4 OccupationIndemnitor #5 First Last Indemnitor #5 relationshipIndemnitor #5 Annual IncomeIndemnitor #5 Occupation COLLATERALProperty Location (1)OwnerFMV1st Lien2nd Lien100% Equity80% Equity DOCUMENTATION CHECKLISTCompleted Bail Bond Application* Yes No Completed Indemnity Agreements* Yes No Property CollateralDeed of Trust/Mortgage* Yes No Evidence of Property Value (Tax Assessment, Appraisal, DataQuick, etc)?* Yes No Evidence of Liens (title work, mortgage statement, etc)?* Yes No
