Name
Address
How Long
Landlord/Mortgagee
Phone
Cell
Previous Address
How Long
Email
Age
Marital Status
Date of Birth
Place of Birth
Sex
Race
Height
Eye Color
Hair Color
Weight
Identifying Marks, Scars, Tattoos, etc.
Driver's License
Expires
State
Social Security Number
Automobile Make
Automobile Model
Automobile Year
Body Style
Color
License Plate
Lein Holder
Insurance Company
Employer
Address
Phone
Title
How Long
Monthly Income
***********************SIGNIFICANT OTHER/SPOUSE INFORMATION******************
Spouse Name
Spouse Full Address
Spouse Phone
Spouse Social Security Number
Spouse Drivers License
Spouse DL State
Spouse Date of Birth
Spouse Employer
Spouse Employer Address
Spouse Title
Spouse Employer Phone
THE PREMIUM AND FEES PAID ON THIS BOND ARE NOT REFUNDABLE
DEFENDANT’S REFERENCES:
Name
Relation
Address
Phone
Name
Relation
Address
Phone
Name
Relation
Address
Phone
DEFENDANT’S CHILDREN
Name & Age
Name & Age
Name & Age
Previous Arrests
Any Bonds Now?
Convictions
Where
Probation/Parole
PROMISSORY NOTE THIS NOTE IS BEING EXECUTED BY THE UNDERSIGNED PALMETTO SURETY CORP AS Surety upon forfeiture or estreature of the surety bond(s)posted on behalf of the named defendant. On demand after date for value received, I/We promise to pay to the order of JEFF’S BAIL BONDS, LLC., the sum of _______________________________________Dollars($________) with interest thereon at the rate of Twelve Percent (12%) per annum for Call Date until fully paid. Interest payable semi-annually. The maker and endorser of this note further agree to waive demand, notice of non-payment and protest, and in case a suit shall be brought for the collection hereof, or the same has to be collected upon demand of an attorney, to pay reasonable attorney’s fees for making such collection. After maturity, this Note shall bear interest at Twelve Percent(12%), per annum, semi-annually.
It is further agreed and specifically understood that this Note shall become null and void in the event the said Defendant,__________________________, shall appear in the proper Court at the time(s) so directed by the Judge(s) of competent jurisdiction and the obligations under the appearance bond(s) posted on behalf of the Defendant have been fulfilled and the Surety discharged of all liability thereunder, otherwise to remain in full force and effect.
Defendant Full Name
Date Signed
__________________________________ signature will be required prior to bail process
Indemnitor #1 Name
Indemnitor #1 Address
__________________________________ signature will be required prior to bail process
This Section To Be Filled Out By a Jeff's Bail Bonds Representative:
Bond Amount
Premium
Administration Fee
Jail Fee
Total Due
Amount Paid
Balance Due
Payment Arrangements
Start Date
Amount
SURRENDER FOR NON-PAYMENT OF PREMIUMS
I UNDERSTAND THAT IN THE EVENT THE ABOVE PAYMENT ARRANGEMENTS ARE NOT MET BY EITHER THE DEFENDANT OF THE INDEMNITOR(S), AND IT HAS BEEN THIRTY (30) DAYS SINCE THE DEFENDANT’S RELEASE, THE DEFENDANT WILL BE CONSIDERED IN VIOLATION OF HIS/HER BOND CONDITIONS AND PERCEIVED TO BE A FLIGHT RISK. THIS MAY RESULT IN APPREHENSION, ACCUMULATION OF RECOVERY FEES, AND THE SURRENDER OF THE DEFENDANT.
Defendant
Indemnitor
Indemnitor to sign
Indemnitor
Indemnitor sign
Send