DEFENDANT BAIL BOND APPLICATION

Case Number

Charge(s)

Bond Amount

Court

Division

Date

Time

Defendant’s Name:

Alias:

Date of Birth:

Social Security Number:

Driver’s License Number:

Address:

City:

State:

Zip:

Rent:

Own:

How Long:

Landlord/Mortgage Company

Home Phone:

Cell Phone:

Email:

Male:

Female:

Race:

Height:

Weight:

Hair:

Eyes:

I.D. Scars-Marks-Tattoos:

Bank Name:

City:

State:

Vehicle Make:

Model:

Year:

License Plate Number:

Employer:

Position:

Length of Employment:

Employer Address:

City:

State:

ZIP:

Are you on bond or signed for a bond:

Yes [ ] No [ ]

Bonding Company:

Address:

City:

State:

ZIP:

Phone:

Are you on Probation/Parole

Yes [ ] No [ ]

Probation/Parole Officer:

Address:

City:

State:

ZIP:

Phone:

Significant Other Name: (Husband-Wife-Boyfriend-Girlfriend)

Phone Number:

Home Address:

City:

State:

Zip:

Employer:

Position:

Length of Employment:

Phone:

Employer Address:

City:

State:

ZIP:

Are you on bond or signed for a bond:

Yes [ ] No [ ]

Bonding Company:

Address:

City:

State:

ZIP:

Phone:

Are you on Probation/Parole

Yes [ ] No [ ]

Probation/Parole Officer:

Address:

City:

State:

ZIP:

Phone:

References

Address

City

State

Zip

Phone

Mother:

Father:

Brother:

Sister:

Grandparent:

Emergency Contact:

Emergency Contact:

Emergency Contact:

The following certification must be completed if a signatory cannot read or speak English.

Translation Certification. The undersigned translator makes this affidavit and hereby certifies, under penalty of perjury, that he/she read verbatim and translated this entire document, including all

related documents, bail contracts, indemnity agreements, disclosures, promissory notes, security instruments and trust deeds, to the Indemnitor (s) signing below in his/her primary language.

TRANSLATOR: (signature)

Print Name:

Date:

Address:

City:

State:

ZIP:

Phone:

Confirmo por mi colocacion de mis iniciales que este acuerdo de plan de pago ha sido traducido completamente a satisfaccion. I confirm by my affixing my initials that this contract has been translated to my satisfaction

Initials/iniciales:

X

The undersigned hereby certify the truth of all statements in the application, authorize the Professional Cash Bail Agent to verify this information and to obtain additional information from any source.

Defendant/Principal/Indemnitor (Print)

X

Signature:

X

Date:

Solicitud de traducción. [check box if translation is required] Si no puede leer ni entender inglés, favor de marcar este cuadro.