Online Bonding ApplicationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 5Dual Co-Signer/Indemnitor AgreementRegarding(Please print name of DEFENDANT above)1st Co-Signer/Indemnitor InformationPersonalFull NameDate of BirthPhone NumberSocial Security NumberRelationship to DefendantFacebookTwitterNicknameOwn/RentHome PhoneDriver's License NumberHow long have you known the Defendant?InstagramEmailAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long at this address?Landlord’s NameEmploymentEmployerAddressPhoneIncomeStart DateUnion Member?Supervisor NameLength of EmploymentFrequency of paymentsName of UnionPhysical DescriptionHair ColorWeightEye ColorSexHeightRaceMarkings/TattoosVehicleMakeYearModelLicense Plate NumberColorWhere was it financed?BankingBank Name (where you have your personal accounts)Checking or Savings?OtherSignificant OtherSpouse / Girl/Boy Friend NameSSN#PhoneEmployerEmployer AddressEmployer Phone #Length of EmploymentIncomeNext - Personal References1st Co-Signer/Indemnitor InformationPERSONAL REFERENCESYOU MUST HAVE AT LEAST 41st ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone2nd ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone3rd ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone4th ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone # Work PhoneHow did you hear about us?Friend / Attorney:BackNext - 2nd Co-Signer/Indemnitor Information2nd Co-Signer/Indemnitor InformationPersonal InformationFull NameDate of BirthPhone NumberSocial Security NumberRelationship to DefendantFacebookTwitterNickname Own/RentHome Phone Driver's License NumberHow long have you known the Defendant?InstagramEmailAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long at this address?Landlord’s NameEmploymentEmployerAddressPhone #IncomeStart DateUnion Member?Supervisor NameLength of EmploymentFrequency of paymentsName of UnionPhysical DescriptionHair ColorWeightEye ColorSex Height RaceMarkings/TattoosVehicleMakeYearModelLicense Plate NumberColor Where was it financed? BankingBank Name (where you have your personal accounts)Checking or Savings?OthersSignificant OtherSpouse / Girl/Boy Friend NameSSN#PhoneEmployerEmployer AddressEmployer Phone #Length of EmploymentIncomeBackNext - Personal References2nd Co-Signer/Indemnitor InformationPERSONAL REFERENCESYOU MUST HAVE AT LEAST 41st ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone2nd ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone3rd ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work Phone4th ReferenceNameAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone #Work PhoneHow did you hear about us?Friend / Attorney:BackNext -> AgreementIMPORTANT: READ AND SIGN INDEMNITOR AGREEMENTBAIL BOND AGREEMENTNamehereby agree to the following terms and conditions in consideration for Break Em Out Bail Bonds and/or Chapmans Bail Bonds and its agents acting as surety on my bond:To APPEAR IN COURT on all dates indicated by the bail bondsman, my attorney, the court, or clerk of the court for any and all courts where I have a case or cases pending.To CALL your bail bondman every Tuesday TO CHECK IN UNTIL ALL CASES HAVE BEEN DISMISSED OR RESOLVED. You can call the check in line at (254)400-2404 to here your court dates.To REPORT ANY CHANGES in address, telephone number, or employment to BEO and/or Chapmans Bail Bonds.To PAY as agreed in the “Payment Agreement.”To NOTIFY Break Em Out and/or Chapmans Bail Bonds within 24 HOURS if subsequently ARRESTED.I understand that failure to comply with any of the above requirements may result in Break Em Out and/or Chapmans Bail Bonds filing an Affidavit of Surety to Surrender, which will result in a warrant being issued for my arrest. I also understand that if this occurs, no fees, cash deposits or collateral are refundable.I understand that if I default in my payments, a charge of “Theft of Services” may be filed against me, resulting in a warrant being issued for my arrest.I understand that BAIL JUMPING is an offense punishable by up to FIVE YEARS in prison.“Mobile Device Account Verification” (One‐Time Verification): By submitting your application, you agree with the Terms and Conditions outlined therein for use of our services, and authorize your disclosure, and your financial institution and telephone carrier to disclose information to us and our vendors from you and your account and about you, including (if available): name, billing address, email, phone number, financial, credit and personal information.“Mobile Device LocationVerification” (Opt‐In Verification): As part of our security measures to help prevent fraud and identity theft, when submitting your application and future transactions, you agree to allow us to verify that your mobile phone is in proximity to the transaction location, and when signing into your account, to verify that you are near the transacting computer. This location verification data will be saved with other transaction information and will be available for use in resolving any concerns you may have. If you choose to opt‐out at some point, you may do so by visiting www.mdnoptout.com and submit your name and mobile number, or you may contact Chase Chapman at 254-400-2663.Service Agreement I further agree that in the event the principal (client) should fail to appear in any court that this Surety Company has bonds outstanding in, the cosigner will pay the Surety, in certified funds, the face value of all bonds forfeited plus the cost of court for each bond within 30 days of the failure to appear date.I UNDERSTAND THAT IF I FAIL TO CHECK IN I will go back to jail with no liability towards Break Em Out Bail Bonds or Chapmans Bail Bonds.BOTH HAVE THE OPTION TO SURRENDER MY BOND IN WHICH CASE A WARRANT WILL BE ISSUED FOR MY ARREST AND I WILL GO BACK TO JAIL.Co-Signer Signature & Name Clear SignatureDate / TimeCo-Signer Signature & Name Clear SignatureDate / Time BEO or Chapmans Employee Clear SignatureDate / TimeNotary Signature Clear SignatureNotary Date / TimeNotary StampALL PARTIES HAVE HAD THE OPPORTUNITY TO ASK ANY QUESTIONS I MAY HAVE AS WELL AS READING THOROUGHLY THE AGGREEMENT I AM SIGNING REGARDING MY RESPONSIBILITY AS CO-SIGNERS FORSubmit