#4

Underwriting Application & Defendants Contract

All questions must be answered in full. Any false statements will be grounds for us to surrender you.

You must notify us immediately of any change in the information provided below.

Failure to notify us will result in your surrender.

Premium paid on this bond is not refundable.

Defendant's First Name *

Defendant's Last Name *

Defendant's Phone *

Defendant's Email

How did you hear about us?

Who at Bail-ey Bonds is helping you? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Tell us about the case...

Attorney name

Jail

Charges

Date of arrest

Power #

Surety

Court

Bail-Ey Bonds Amount *

Promissory Note *

$

Defendant info

Defendant Nickname (street)

Defendant DL/I.D.#

DL/I.D.# Expiry Date

Defendant date of birth

Place of birth

Defendant SSN *

Height *

Weight *

Eye color *

Hair color *

Defendant's Race *

Scars/tatoos/marks, etc

Defendant's Gender *

Are you a twin?

Yes

No

Shoe size

Do you wear glasses?

What brand of cigarettes do you smoke?

What's your favorite hangout spot?

Who do you ride/hang around with?

Last school

Roommate?

Bank/location

Do you receive ssi or food stamps?

What date do you receive funds?

Facebook Page URL

Twitter Username

Defendant's Address

Apt. Name

Apt#

Address

City

State

Postal code

LL/Owner?

How long have you been there?

Additional/change of address

Current Stats

Do you have any previous arrests?

What were you arrested for?

Where where you arrested?

Previous bond company?

Currently on bond?

Yes

No

Where are you bonded at?

Prob/parole officer?

Employment

Pres/prev employer

Supervisor name:

How long have you been there?

Job Address

Job title

Job Phone

Job Schedule

Job Parking

Pay schedule

Family

Spouse/ex spouse?

Their D.O.B

Their SS #

Maiden name

Their Occupation

How long was/is the relationship?

Their Employer Name

Their Employer Address

Their Employer Phone

Do you have any kids? *

No

Yes

Child #1

Name

Age

Address

Phone

School / Employer

Do you have more than 1 kid? *

Yes

No

Child #2

Name

Age

Address

Phone

School / employer

Do you have more than 2 kids? *

Yes

No

Child #3

Name

Age

Address

Phone

School / employer

Transportation

Vehicle make

Vehicle Year

Vehicle Color

Vehicle Model

What state is it registered in?

Vehicle tag #

Amount Owed on Vehicle

$

Lien Holder Name

In whos name is the vehicle?

Insurance

Insurance office location

Relative/Friends

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Mother Name

Home address

Home phone #

Employment

Work address

Work phone #

Father

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Father Name

Home phone #

Home address

Employment

Work address

Work phone #

Brother

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Brother Name

bro Home address:

bro Home phone #

bro Work address

bro Work phone #

bro Employment

Sister

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Sister Name

sis Home phone #

sis Home address:

sis Work address

sis Employment

sis Work phone #

Grandparent

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Grandparent Name

grand Home phone #

grand Home address:

grand Work address

grand Work phone #

grand Employment

Best Friend

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Best Friend Name

best Home phone #

best Home address:

best Work address

best Work phone #

best Employment

Friend

Fill out as much info as you can provide. Click NEXT if you can't provide any info.

Friend Name

friend Home phone #

friend Home address:

friend Employment

friend Work phone #

friend Work address

You're almost done, just click "SUBMIT"!

Remember, all questions must be answered in full. Any false statements will be grounds for us to surrender you.

You must notify us immediately of any change in the information provided below.

Failure to notify us will result in your surrender.

Premium paid on this bond is not refundable.

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