Home Again Bail Bonds LLC P.O Box 2231 Winchester, VA Hour Phone Line Fax:
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1 APPLICATION FOR BAIL BOND AND INDEMNITOR APPLICATION PLEASE WRITE NEATLY Name of person in jail Booking Name True Name Defendant is a US citizen Yes or No DOB Sex Race Height Weight Eye Color Glasses Hair Color Moustache/Beard I.D. Marks/ Tattoos and location Place of Birth Soc Sec. # D.L # State Issued In Expiration Date Listed Date Received Date of Arrest Where Held Charge(s) County/City Case # Case # Case # Court Court Date Time County Previous Arrest Charge(s) Court County State Arrest Date Disposition Amount of Bail Previous Bail By Whom On Probation or Parole Where Probation or Parole Officer Phone HOME PHONE CELL PHONE DL# or ID # DOB SS# ADDRESS OWN RENT HOW LONG CITY STATE ZIP Children Names and Ages OCCUPATION Monthly Income Supervisor How long EMPLOYER HOW LONG 1 P a g e
2 SIGNIFICANT OTHER Name Home Phone Cell Phone Work Phone EXT OCCUPATION EMPLOYER HOW LONG List Family References- who DO NOT live at the same location (please notify your references, they will be contacted immediately to verify information) 1. NAME RELATIONSHIP ADDRESS CITY ZIP CODE HOME PHONE CELL 2. NAME RELATIONSHIP ADDRESS CITY ZIP CODE HOME PHONE CELL List Three Personal References (please notify your references, they will be contacted immediately to verify information) Name Address Phone # Cell# Relationship Co-Signer s Personal Information (ALL QUESTIONS MUST BE ANSWERED IN FULL) Co-Signer is a US citizen Yes or No NAME RELATIONSHIP What is your relationship with Defendant? How long have you known Defendant? HOME PHONE CELL PHONE DL# or ID # DOB SS# 2 P a g e
3 ADDRESS OWN RENT HOW LONG CITY STATE ZIP OCCUPATION EMPLOYER HOW LONG EMPLOYER ADDRESS WORK PHONE EXT SIGNIFICANT OTHER Name Home Phone Cell Phone Work Phone EXT OCCUPATION EMPLOYER HOW LONG List Family References- who DO NOT live at the same location (please notify your references, they will be contacted immediately to verify information) 1. NAME RELATIONSHIP ADDRESS CITY ZIP CODE HOME PHONE CELL 2. NAME RELATIONSHIP ADDRESS CITY ZIP CODE HOME PHONE CELL Conditions of bond(s) for Defendant: If Defendant: a. Fails to report by PHONE / PERSON every until cause is disposed of in court. b. Fails to pay for the bail bond fee as agreed. c. Changes address or phone number without notifying Home Again Bail Bonds LLC in writing. This also applies to any references given upon release from jail. d. Leaves the county for extended periods of time without notifying Home Again Bail Bonds LLC. e. Fails to advise Home Again Bail Bonds LLC of any and ALL court dates before and after court. f. Fails to notify Home Again Bail Bonds LLC of any other charges that are pending in any other county in or out of the State. Will result in Bond revocation. 3 P a g e
4 INDEMNITOR INFORMATION 1. The Indemnitor(s) will have the defendant(s) forthcoming before the court named in the bond, at the time therein fixed, and may be further ordered by the court. 2. The Indemnitor(s) is responsible for any and all losses or costs of any kind whatsoever which the Surety may incur as a result of this undertaking. There should not be any costs or losses provided the defendant(s) does not violate the conditions of the bond and appears on time at all required court hearings. INDEMINTOR ACKNOWLEDGMENT I have read and received a receipt of monies, I understand and agree that should any breach of the conditions listed above occur, I request/consent that the principal (defendant) be surrendered by Home Again Bail Bonds LLC and agree to pay all costs incurred by Home Again Bail Bonds LLC as a result if this undertaking. The undersigned hereby warrants that the declarations made and answers given in the Application for Bail Bond(s) are the full and complete truth. Any person who includes false or misleading information on the Application for Bail Bond may be subject to criminal and civil penalties as provided by Virginia State law. 4 P a g e
5 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 Home Again Bail Bonds LLC, and/or its Agent(s) harmless from any and all cost and expenses that me be incurred by the Insurance Company and/or Home Again Bail Bonds LLC and/or its 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. Indemnitor Sign DATE Print Defendant Sign DATE Print WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENET 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. 5 P a g e
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