Defendant Bail Agreement Application

Defendant Information

Defendant's Name*

First Last

Where Held*

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*

(The amount of bond needed to be posted)

SS#*

US Citizen*

Yes
No

ID*

State of Issuing ID*

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*

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

Max. file size: 32 MB.

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*

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*

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.