Online Bonding Application

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Step 1 of 5

Dual Co-Signer/Indemnitor Agreement

Regarding

(Please print name of DEFENDANT above)

1st Co-Signer/Indemnitor Information

Personal

Full Name

Date of Birth

Phone Number

Social Security Number

Relationship to Defendant

Facebook

Twitter

Nickname

Own/Rent

Home Phone

Driver's License Number

How long have you known the Defendant?

Instagram

Address

Address Line 1

Address Line 2

City

State

Zip Code

How long at this address?

Landlord’s Name

Employment

Employer

Address

Phone

Income

Start Date

Union Member?

Supervisor Name

Length of Employment

Frequency of payments

Name of Union

Physical Description

Hair Color

Weight

Eye Color

Sex

Height

Race

Markings/Tattoos

Vehicle

Make

Year

Model

License Plate Number

Color

Where was it financed?

Banking

Bank Name (where you have your personal accounts)

Checking or Savings?

Other

Significant Other

Spouse / Girl/Boy Friend Name

SSN#

Phone

Employer

Employer Address

Employer Phone #

Length of Employment

Income

1st Co-Signer/Indemnitor Information

PERSONAL REFERENCES

YOU MUST HAVE AT LEAST 4

1st Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

2nd Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

3rd Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

4th Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

How did you hear about us?

Friend / Attorney:

2nd Co-Signer/Indemnitor Information

PERSONAL REFERENCES

YOU MUST HAVE AT LEAST 4

1st Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

2nd Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

3rd Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

4th Reference

Name

Address

Address Line 1

City

State

Zip Code

Phone #

Work Phone

How did you hear about us?

Friend / Attorney:

IMPORTANT: READ AND SIGN INDEMNITOR AGREEMENT

BAIL BOND AGREEMENT

Name

hereby agree to the following terms and conditions in consideration for Break Em Out Bail Bonds and/or Chapmans Bail Bonds and its agents acting as surety on my bond:

To APPEAR IN COURT on all dates indicated by the bail bondsman, my attorney, the court, or clerk of the court for any and all courts where I have a case or cases pending.

To CALL your bail bondman every Tuesday TO CHECK IN UNTIL ALL CASES HAVE BEEN DISMISSED OR RESOLVED. You can call the check in line at (254)400-2404 to here your court dates.

To REPORT ANY CHANGES in address, telephone number, or employment to BEO and/or Chapmans Bail Bonds.

To PAY as agreed in the “Payment Agreement.”

To NOTIFY Break Em Out and/or Chapmans Bail Bonds within 24 HOURS if subsequently ARRESTED.

I understand that failure to comply with any of the above requirements may result in Break Em Out and/or Chapmans Bail Bonds filing an Affidavit of Surety to Surrender, which will result in a warrant being issued for my arrest. I also understand that if this occurs, no fees, cash deposits or collateral are refundable.

I understand that if I default in my payments, a charge of “Theft of Services” may be filed against me, resulting in a warrant being issued for my arrest.

I understand that BAIL JUMPING is an offense punishable by up to FIVE YEARS in prison.

“Mobile Device Account Verification” (One‐Time Verification):
By submitting your application, you agree with the Terms and Conditions outlined therein for use of our services, and authorize your disclosure, and your financial institution and telephone carrier to disclose information to us and our vendors from you and your account and about you, including (if available): name,
billing address, email, phone number, financial, credit and personal information.

“Mobile Device LocationVerification”
(Opt‐In Verification):
As part of our security measures to help prevent fraud and identity theft, when submitting your application and future transactions, you agree to allow us to verify that your mobile phone is in proximity to the transaction location, and when signing into your account, to verify that you are near the transacting computer. This location verification data will be saved with other transaction information and will be available for use in resolving any concerns you may have. If you choose to opt‐out at some point, you may do so by visiting www.mdnoptout.com and submit your name and mobile number, or you may contact Chase Chapman at 254-400-2663.

Service Agreement
I further agree that in the event the principal (client) should fail to appear in any court that this Surety Company has bonds outstanding in, the cosigner will pay the Surety, in certified funds, the face value of all bonds forfeited plus the cost of court for each bond within 30 days of the failure to appear date.

I UNDERSTAND THAT IF I FAIL TO CHECK IN I will go back to jail with no liability towards Break Em Out Bail Bonds or Chapmans Bail Bonds.

BOTH HAVE THE OPTION TO SURRENDER MY BOND IN WHICH CASE A WARRANT WILL BE ISSUED FOR MY ARREST AND I WILL GO BACK TO JAIL.

Co-Signer Signature & Name

Clear Signature

Date / Time

Co-Signer Signature & Name

Clear Signature

Date / Time

BEO or Chapmans Employee

Clear Signature

Date / Time

Notary Signature

Clear Signature

Notary Date / Time

Notary Stamp

ALL PARTIES HAVE HAD THE OPPORTUNITY TO ASK ANY QUESTIONS I MAY HAVE AS WELL AS READING THOROUGHLY THE AGGREEMENT I AM SIGNING REGARDING MY RESPONSIBILITY AS CO-SIGNERS FOR

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Online Bonding Application

Dual Co-Signer/Indemnitor Agreement

1st Co-Signer/Indemnitor Information

Employment

Physical Description

Vehicle

Banking

Significant Other

1st Co-Signer/Indemnitor Information

PERSONAL REFERENCES

1st Reference

2nd Reference

3rd Reference

4th Reference

2nd Co-Signer/Indemnitor Information

Employment

Physical Description

Vehicle

Banking

Significant Other

2nd Co-Signer/Indemnitor Information

PERSONAL REFERENCES

1st Reference

2nd Reference

3rd Reference

4th Reference

IMPORTANT: READ AND SIGN INDEMNITOR AGREEMENT

BAIL BOND AGREEMENT

Notary Stamp