defendant application

Throughout Colorado

Fill out every field in the form. If you don’t have information for a certain field just put N/A

DEFENDANT BAIL BOND APPLICATION

This field is for validation purposes and should be left unchanged.

Case #1

Case Number:(Required)

Charge(s):(Required)

Bond Amount:(Required)

Court:(Required)

Division:(Required)

Date(Required)

Time(Required)

Case #2

Case Number:

Charge(s):

Bond Amount:

Court:

Division:

Date

Time

Case #3

Case Number:

Charge(s):

Bond Amount:

Court:

Division:

Date

Time

“ALL HIGHLIGHTED QUESTIONS MUST BE ANSWERED IN FULL” “ FALSE INFORMATION MAY TERMINATE THIS BOND!”

Defendent's Name(Required)

Alias

Date in Birth(Required)

Social Security Number(Required)

Driver's License Number(Required)

Address(Required)

Street Address City State ZIP Code

Rent(Required)

Own(Required)

How long(Required)

Landlord/Mortgage Company(Required)

Home Phone:(Required)

Cell Phone:(Required)

Email(Required)

Gender:(Required)

Male

Female

Race:(Required)

Height:(Required)

Weight(Required)

Hair:(Required)

Eyes:(Required)

I.D. Scars-Marks-Tattoos:(Required)

Bank Name:(Required)

City:(Required)

State:(Required)

Vehicle Make:(Required)

Model:(Required)

Year:(Required)

License Plate Number:(Required)

Employer:(Required)

Length of Employment:(Required)

Position:(Required)

Employer Address:(Required)

Street Address City State ZIP Code

Are you on bond or signed for a bond:(Required)

Yes

Bonding Company:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Are you on Probation/Parole:(Required)

Yes

Probation/Parole Officer:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Significant Other Name: (Husband-Wife-Boyfriend-Girlfriend):(Required)

Phone Number:(Required)

Home Address:(Required)

Street Address City State ZIP Code

Employer:(Required)

Position:(Required)

Length of Employment:(Required)

Phone:(Required)

Employer Address:(Required)

Street Address City State ZIP Code

REFERENCES -------------------------------------------------------------------------------------------------------------------

Mother:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Father:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Brother:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Sister:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Grandparent:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Emergency Contact:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Emergency Contact:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

Emergency Contact:(Required)

Phone(Required)

Address:(Required)

Street Address City State ZIP Code

The following certification must be completed if a signatory cannot read or speak English.

Translation Certification. The undersigned translator makes this affidavit and hereby certifies, under penalty of perjury, that he/she read verbatim and translated this entire document, including all related documents, bail contracts, indemnity agreements, disclosures, promissory notes, security instruments and trust deeds, to the Indemnitor (s) signing below in his/her primary language.

TRANSLATOR: (signature)

Print Name:

Date

Phone:

Address:

Street Address City State ZIP Code

The undersigned hereby certify the truth of all statements in the application, authorize the Professional Cash Bail Agent to verify this information and to obtain additional information from any source.

Defendant/Principal/Indemnitor (Print)(Required)

Signature:(Required)

Date(Required)