Mr. Bail Application Form

Bond Amount

Power #

Collateral Receipt #

Defendant’s Booking Name *

First

Last

True Name/Alias

First

Last

Indemnitor/Co-Signer Name *

First

Last

Indemnitor Home Phone *

Indemnitor Cell Phone *

Indemnitor Address *

Address Line 1

Address Line 2

City

State

Zip Code

Indemnitor Social Security # *

Indemnitor Driver's License # *

Indemnitor Date of Birth//

Indemnitor Relation

Indemnitor Occupation

Indemnitor Employer

Indemnitor Employment Length

Indemnitor Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Indemnitor Work Phone

Indemnitor Spouse *

First

Last

Indemnitor Spouse Cell #

Indemnitor Spouse Work #

Indemnitor Spouse Occupation

Indemnitor Spouse Employer

Indemnitor Spouse Employment Length

Indemnitor Spouse Employeer Address

Address Line 1

Address Line 2

City

State

Zip Code

Indemnitor Bank Name

Account Type

Checking
Savings

Indemnitor Monthly Income

REFERENCES:

References Name #1

First

Last

Address

Phone

Relationship

References Name #2

First

Last

Address

Phone

Relationship

References Name #3

First

Last

Address

Phone

Relationship

I/WE HAVE READ THE FOREGOING AND FULLY UNDERSTAND THIS AGREEMENT

I/We certify that the above information is true and correct. I/We also understand and acknowledge that by signing below, I/We am/are agreeing to indemnify and hold the Insurance Company and/or Mr. Bail Inc. and/or it’s Agent harmless from any and all cost and expenses that may be incurred by the Insurance Company and/or Mr. Bail Inc. and/or it’s Agent in the event that the said defendant fails to appear for any and all court dates. Also, I/We further understand that this is an application for a type of credit and authorize a review of my credit history (via) credit reporting agency checks.

WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER, FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION MAY BE FOUND GUILTY OF A FELONY.

Defendant’s/ Indemnitor’s Signature

Defendant Sign Date

Indemnitor’s Signature

Indemnitor Sign Date

In Jail, Call Mr. Bail! Just 1% to 5% Down

MR. BAIL APPLICATION FOR BAIL BOND AND INDEMNITY AGREEMENT

REFERENCES:

I/WE HAVE READ THE FOREGOING AND FULLY UNDERSTAND THIS AGREEMENT

ABOUT MR. BAIL IDAHO

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