Bail Bond Application


Please fill out the information below and click submit to apply.
  • Part I - Business

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

  • Business Address

  • How long at this address?



  • Home Address

  • How long at this address?



  • A producer is an independent contractor not an employee.

  • Part II - Background Information




  • If YES, list amount and company





  • Part III - References

  • Please submit three letters of reference or names and phone numbers of three personal references. References should not include relatives, supervising agent and/or staff in office.



  • Part IV - General Information


  • Part V - Certification

  • 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.


  • Signature PIN - Please enter a combination of 6 letters and numbers. This will serve as your electronic signature.