Online Application

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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