Bail Bond Application Form

BAIL BOND APPLICATION FORM

This Bail Bond Application (the "Application") is entered into by Applicant Name: and Surety / Bonding Company Name: . Effective Date:

Recitals

WHEREAS, Defendant Name: has been charged in Case Number: in the Court: .

WHEREAS, Bail Amount: $ has been set and Applicant requests a bail bond to secure Defendant's release; and

WHEREAS, Surety is authorized to underwrite and issue bail bonds subject to the terms and collateral requirements set forth herein.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows.

1. Bond Issuance

Upon acceptance of this Application by Surety, Surety shall issue a bail bond (the "Bond") in the amount of $ to secure Defendant's appearance. The Bond shall be conditioned upon Defendant's compliance with all court orders and appearance obligations.

2. Applicant Information

3. Defendant and Case Details

4. Entity Type and Role

Applicant Entity Type: Individual Corporation Partnership Trust Other

5. Premium, Fees and Collateral

Premium Amount Due $. Applicant acknowledges the premium is earned upon issuance of the Bond and is non-refundable except as required by applicable law.

Applicant grants Surety a security interest in the collateral described above and any additional collateral posted in support of the Bond. Applicant agrees that Surety may perfect, sell or otherwise dispose of collateral upon default to satisfy any indebtedness, fees, costs and judgment arising from the Bond.

6. Indemnity and Reimbursement

Applicant hereby indemnifies, defends and holds harmless Surety from and against any and all losses, liabilities, costs, attorneys' fees, court costs, expenses, and interest arising from issuance of the Bond or enforcement of this Application. Applicant shall pay on demand all sums paid by Surety under the Bond, together with reasonable attorneys' fees and collection costs.

7. Representations and Warranties

Applicant represents and warrants that the information provided in this Application is true, complete and correct in all material respects. Applicant acknowledges that Surety will rely upon these representations in underwriting the Bond and that any material misrepresentation is a default under this Application and the Bond.

8. Authorization and Release

Applicant authorizes Surety and its agents to obtain and verify credit, background, employment and criminal history information. Applicant further authorizes employers, financial institutions, governmental agencies and others to release such information to Surety. Applicant consents to a photocopy or electronic transmission of this Application as if it were an original.

Applicant authorizes background and credit checks

9. Default; Remedies

In the event of breach, default, forfeiture, failure to surrender Defendant, or failure to comply with any court condition, Applicant shall immediately reimburse Surety for the full penal sum of the Bond and all costs incurred. Surety shall have the right to pursue all remedies at law or equity, including suit on this indemnity, pursuit of collateral, and appointment of a receiver for collateral.

10. Notices

All notices required under this Application shall be in writing and shall be deemed given when delivered personally or sent by certified mail, return receipt requested, to the addresses set forth below.

11. Governing Law; Venue

This Application and any Bond issued in reliance hereon shall be governed by and construed in accordance with the laws of the jurisdiction where the Bond is filed. Venue for any action arising hereunder shall be in the courts having subject matter jurisdiction where the Bond was posted.

12. Entire Agreement; Severability; Amendments; Waiver

This Application, together with any schedules, attachments and the Bond, constitutes the entire agreement between Applicant and Surety with respect to the subject matter hereof. If any provision is held invalid, such invalidity shall not affect other provisions. No amendment or waiver shall be effective unless in writing and signed by both Applicant and an authorized representative of Surety. No failure or delay in exercising any right shall operate as a waiver of that right.

13. Additional Provisions

Applicant acknowledges that Surety may require additional indemnitors, collateral, conditions or a co-signer as a condition to issuance of the Bond. Applicant agrees to execute any additional documents reasonably necessary to effectuate the security interest and indemnity granted herein.

Acknowledgment and Certification

By signing below, Applicant certifies under penalty of perjury that the information provided in this Application is true and correct, that Applicant understands the obligations arising from execution of this Application and the Bond, and that Applicant is legally authorized to grant the rights and security interests set forth herein.

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