Bail Bonds Application

All In Character Info Do Don't Put Your Real Life Info Here Only Put Your In Game Info Here




U.S.A. I Din't Do It Bail Bonds Application


APPLICATION FOR BAIL Agency / Producer
Notice to Applicant: FEDERAL LAW – VIOLENT CRIME CONTROL AND LAW ENFORCEMENT
ACT OF 1994, 18 U.S.C. SECTION 1033 prohibits certain activities by or affecting persons engaged, or
proposing to become engaged, in the business of insurance:
(e)(1)(A) Any individual who has been convicted of any criminal felony involving
dishonesty or a breach of trust, or who has been convicted of an offense under this
section, and who willfully engages in the business of insurance whose activities
affect interstate commerce or participates in such business, shall be fined as
provided in this title or imprisoned not more than 5 years, or both.
(B) Any individual who is engaged in the business of insurance whose activities affect
interstate commerce and who willfully permit the participation described in
subparagraph (A) shall be fined as provided in this title or imprisoned not more
than 5 years, or both:
(e)(2) A person described in paragraph (1)(A) may engage in business of insurance
or participate in such business if such person has the written consent of any
regulatory official authorized to regulate the insurer, which consent
specifically refers to 18 U.S.C. Sections 1033 and 1034.
You must answer every question on the Application. If a question does not apply, indicate N/A in the space provided for the
answer. Your answers are not limited to the space provided on the Application. Attach additional pages as needed. The
Surety will not process incomplete Applications. Additional information may be requested.
(PLEASE TYPE OR PRINT ALL INFORMATION ON THIS APPLICATION)
SECTION I APPLICANT INFORMATION
Applicant Name
AKA (maiden name, etc.) e-mail address
Home Address
Street City County State Zip
Home Phone # Cell Phone #
Date of Birth Place of Birth U.S. Citizen (yes) (no)
City / State / Country
Social Security # Driver’s License # (attach copy)
Have you ever-declared bankruptcy: (yes) (no) (If yes, attach an explanation.)
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SECTION II SPOUSE INFORMATION MARRIED --- YES ( ) NO ( )
Name of Spouse AKA (maiden name)
Date of Birth Spouse SS#
Spouse Employer Work #
SECTION III APPLICANT EDUCATION
Highest level of education achieved: High School Associate Bachelors Advanced Major:
Name of Institution: Graduation Date:
SECTION IV LICENSE INFORMATION
Do you have a current in-force bail bond license: (yes) (no) License #
License expiration date (Attach copies of all licenses) How long have you been licensed?
List all states (and counties) you are licensed in:

What states (and counties) have you been licensed in?
List all Insurance Companies and Agents/General Agents that you have issued bail bonds for and/or been appointed with:
Dates (From/To) Insurance Company or Agent/General Agent Name


Are you engaged in any other business or occupation? (yes) (no) If yes, Nature of business:
Name & Address of Business:
How long? Owner ‘s Name:
SECTION V BUSINESS INFORMATION
Legal Business Name: (Attach list of all DBA names)
Type of Business (circle one): Corporation Partnership Sole Proprietorship DBA Other
Business Address:
# and Street City County State Zip
Mailing Address:
Business Phone #: Fax #: Page 3 of 5
Biz Website: Biz E-mail:
How long have you done business under this name? Tax ID#
Does agency have a current in-force bail bond license? (yes) (no) License #:
License Expiration Date: (Attach copies of all licenses) How long has agency been licensed?
List all states (and counties) the agency is currently licensed in:

What states (and counties) has the agency been licensed in previously?
Location of Agency bail offices:

Estimate of number of bonds written monthly by denomination ……
________ $5,000 ________ $10,000 ________ $25,000 ________ $50,000 ________ $100,000 ________ $250,000
Estimate of yearly liability of bonds that you write
Do you currently have a Build-Up-Fund with another insurance company? (yes) (no)
If yes, Insurance Company Name :_______________________________________ BUF Balance: ______________________
Company Name :_______________________________________ BUF Balance: ______________________
Have you ever had bond forfeiture payments paid out of your BUF? (yes) (no)
If yes, please explain why:

Please include list of all employees working with your bail company.
SECTION VI APPLICANT CRIMINAL AND REGULATORY HISTORY
Have any disciplinary actions ever been taken by any regulatory agency against you, your business or any business with which
you have been directly connected? (yes) (no)
(If yes, attach a full explanation.)
Have you ever been denied or refused a bail license? (yes) (no)
(If yes, attach a full explanation)
Have you ever had a bail license suspended or revoked? (yes) (no)
(If yes, attach a full explanation)
Have you ever had your bail contract cancelled by a surety or general agent? (yes) (no)
(If yes, please attach specific information surety name, reasons, when, etcetera.)
Have you ever been arrested, charged, convicted of or pled nolo conterdere (no contest) to a felony, gross misdemeanor or a
misdemeanor involving moral turpitude or currently have pending any misdemeanor or felony charges against you?
(Misdemeanor does not mean minor traffic violations.)

Date :

Your Signature :