I hereby certify that all entries on both pages and attachments are true and complete, and I agree and understand that
any falsification of information herein, regardless of the time of discovery, may cause forfeiture on my part to any
contract of Bail USA, Inc. it’s Indemnitors, General Agent’s and Re-Insurers, all of
which shall hereafter be termed the Company.
This information is to be used for possible contractual agreement between myself, and the Company; It will not be made available
for public inspection.
I agree to conduct myself in a legal and professional manner while acting as an independent contractor at all times.
Should my conduct or that of my employees, contractors, or principals result in a civil or criminal complaint I release
Bail USA, Inc. from ANY and ALL liability as a result of my actions.
I hereby authorize any person, agency, partnerships or corporation having any information concerning my character,
financial reputation and/or criminal background to release such information to the Company. I also release such person,
agency, partnerships or corporation from any liability which may be incurred in releasing this information to the Company,
including liability under any Federal Laws.