Defendant Bail Agreement Application

Defendant Information

Defendant's Name*

First Last

RNI/Booking #*

Date of Birth*

Current Address*

Street Address City State ZIP Code

Email*

Home Phone #

Cellular Phone #*

Check One*

Own
Rent
Living with Family

Monthly Payment or Rent*

How long?*

Bond Amount*

City / State*

Where Held?*

Charges*

Court*

Case #*

Date and Time To Appear*

Arrested By

SS#*

ID*

State of Issuing ID*

US Citizen*

Yes
No

Residence Alien #

Race

Sex

Height

Weight

Hair

Eyes

ID Marks/Tattoo

Yes
No

Where and What

Vehicle Make and Model

Vehicle Year and Color

Vehicle License# and State

On Probation*

Yes
No

Where

Probation Officer

Cases Pending

Yes
No

Where Pending

Previous Bail

Yes
No

Where

With Whom

Military Branch

Service #

Discharge Date

Union Member

Local

Defendant's Attorney

Attorney's Phone #

Employment Information

Employment Type*

W2 Employee
1099/Self Employed
Fixed income

Current Employer or Retired From*

Employer Phone #

Employer Address

Street Address Address Line 2 City State ZIP Code

How long?

Position

Income (Monthly)

BANKING AND CREDIT INFORMATION

Bank Name*

City*

Checking/Savings Balance*

Would you like to upload your identification or text it to us?*

Upload Identification
Text photo of identification

Identification File

Drop files here or

Please upload your driver license or identification card, paycheck sub, and a utility bill.

We need your driver license or identification card, paycheck sub, and a utility bill. if you do not have a scanner please take a photo with your phone, then text to 702-333-2663. If you do not have all of this information, we will use other means to verify identity.

Credit Cards, Other Loans

1) Name

Company

Current Balance

Monthly Payment

2) Name

Company

Current Balance

Monthly Payment

3) Name

Company

Current Balance

Monthly Payment

Mortgage Company

Name

Address

Value

Equity

Amount Due

Auto Loan

Name

Company

Current Balance

Monthly Payment

Defendant's Family Information

Defendant's Mother's Name

Address/City/State/Zip

Phone

Defendant's Father's Name

Address/City/State/Zip

Phone

Defendant's Sibling's Name

Address/City/State/Zip

Phone

Defendant's Sibling's Name

Address/City/State/Zip

Phone

Defendant's Child's Name

Address/City/State/Zip

Phone

Defendant's Child's Name

Address/City/State/Zip

Phone

Defendant's Best Friend's Name

Address/City/State/Zip

Phone

Referral List

1) Name

Relationship

Cell Phone

2) Name

Relationship

Cell Phone

3) Name

Relationship

Cell Phone

Fee Information

Nevada Revised Status requires all Bail Bond Agencies charge 15% of the bond or $50.00 whichever is greater. Please understand that this is the law, Bail Bond Agencies may not charge more or less than 15% of the bond or $50.00 whichever is greater. All Nevada jails require a $50.00 per bond fee paid when a bond is posted at any jail or court. One bond posted is $50.00, two bonds posted is $100.00, three bonds posted is $150.00 and so on.