Online Application

Company

This field is for validation purposes and should be left unchanged.

You, the undersigned indemnitor ("Indemnitor" or "you"), represent and warrant that the following information is true, complete, and correct, and is provided for the purpose of inducing Crum & Forster Indemnity Company ("Surety") to issue, or cause to be issued, a bail bond for the Defendant named below.

Bond Information

Defendant Name*

Bond Amount*

(Full bond amount, not the premium)

County*

Indemnitor Contact Information

Please provide your personal contact information below.

Relationship to Defendant*

Indemnitor Full Name*

First Last

Nickname/Alias

Indemnitor Email*

Enter Email Confirm Email

Cell Phone*

Work Phone

Home Phone

Social Media Username

Indemnitor Residence

Indemnitor Current Home Address*

Street Address Address Line 2 City State Zip

How long have you lived here?*

Rent or Own?*

Rent

Own

Landlord/Mortgage Company*

Indemnitor Previous Home Address

Street Address Address Line 2 City State Zip

How long did you live there?

Rent or Own?

Rent

Own

Landlord/Mortgage Company

Indemnitor Current Employment Information

Is the Indemnitor Currently Employed?*

Yes

No

Indemnitor Current Occupation*

Indemnitor Employer*

Indemnitor Employer Phone Number*

How Long has the Indemnitor Been Employed Here?*

Indemnitor's Employment Address*

Street Address Address Line 2 City State ZIP Code

Supervisor's Name

Indemnitor Vehicle Information

Vehicle Make*

(Honda, Ford, Toyota, etc.)

Vehicle Model*

Vehicle Year*

(2011, 2019, etc.)

Vehicle Color*

License Plate #*

Where Financed?*

(n/a if not applicable)

Amount Owed?*

(n/a if not applicable)

You Will Need to Provide 3 References to Complete this Application

Indemnitor - Reference 1

Reference 1 - Name*

First Last

Relationship to the Indemnitor*

Phone Number*

Reference 1 - Address*

Street Address Address Line 2 City State ZIP Code

Indemnitor - Reference 2

Reference 2 - Name*

First Last

Relationship to the Indemnitor*

Phone Number*

Reference 2 - Address*

Street Address Address Line 2 City State ZIP Code

Indemnitor - Reference 3

Reference 3 - Name*

First Last

Relationship to the Indemnitor*

Phone Number*

Reference 3 - Address*

Street Address Address Line 2 City State ZIP Code

Indemnitor Signature*

Quick Release Bail Bonds Indemnitor Application & Contract

Wallace/Shoshone County

Bond Information

Indemnitor Contact Information

Indemnitor Residence

Indemnitor Personal Information

Additional Information

Indemnitor Current Employment Information

Indemnitor Marital Status / Spouse Employment

Indemnitor Vehicle Information

You Will Need to Provide 3 References to Complete this Application

Indemnitor - Reference 1

Indemnitor - Reference 2

Indemnitor - Reference 3