Indemnitor Application & Agreement

You, the undersigned indemnitor (“Indemnitor” or “you”), hereby represent and warrant that the following declarations made and answers given are true, complete and correct and are made for the purpose of inducing (“Surety) to issue, or cause to be issued, bail bond(s) or undertaking(s) (singularly or collectively the “Bond”) for the person listed below (“Defendant) using power of attorney number(s) (if known), for the amount and at the court listed below.
Defendant's Name*
First Middle Last
This is the person you are working to bail out of jail.
Attorney's Name
First Last
Bond Amount (in Dollars)*
County*
Name of Court*
1. Indemnitor Name & Address
Relationship to Defendant*
Name*
First Middle Last
Nickname/Alias
Home Phone #*
Cell Phone #
Work Phone #
Email*
Facebook Username
Other Social Media
Please list any other social media accounts you may own.
Current Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How Long?
Landlord/Mortgage Holder*
Rent or Own?*
- Rent
- Own
Former Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How Long?
Landlord/Mortgage Holder*
Rent or Own?*
- Rent
- Own

3. Employment
Occupation*
Employer*
Work Phone*
Length of Employment
Employer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Supervisor's Name

7. Financial Statement / Credit Information
Cash On Hand*
Cash in Bank*
Real Estate Value*
Real Estate Mortgage*
In Whose Name is Title?
Monthly Salary or Wages
Please Sign and Date Below
I agree to the terms set forth on all pages of this Agreement. Signed, Sealed and Delivered on the date below, and by the indemnitor and witness listed below.
Today's Date:*
MM
DD
YYYY
Indemnitor Name*
First Middle Last
Indemnitor Signature*
Witness Name*
First Middle Last
Witness Signature*

1. Indemnitor Name & Address