Contact

Lisa Bolton – Bondswoman

Serving All Of Connecticut 24 hours 7 days a week!

BAIL OUT ANYTIME BAIL FORMS

1. Indemnitor Application & Agreement 2. Premium Financing Agreement & Promissory Note 3.Defendant Application, Authorization Form & Agreement

Step 1 of 7

Notes

Name Of Defendant *

BOND AMOUNT(S) *

RELATIONSHIP TO DEFENDANT *

APPLICATION STARTS HERE

1. BIOGRAPHICAL & RESIDENTIAL

Name: *

First

Middle

Last

My friends/family know me as: *

Date of Birth: *//

Social Security #: *

Telephone #1: *

Telephone #2: *

Current Address: *

Address Line 1

Address Line 2

City

State

Zip Code

How long at current address? *

Who do you live with? *

Check the applicable option: *

Homeowner
Rent
Temporary Residence

AGREEMENT

6. TERMS OF BAIL BOND AGREEMENT *

I HAVE READ AND UNDERSTAND THE TERMS OF THE BAIL BOND AGREEMENT. BY CLICKING, I AGREE TO FULFILL ALL IT'S PROVISIONS WITHOUT RESERVATION. THIS CONTRACTUAL AGREEMENT SATISFIES ANY AND ALL ACKNOWLEDGEMENT REQUIREMENTS THEREBY VALIDATING THE ABOVE CONDITIONS.

A. COURT APPEARANCE a. I will ensure that the Individual being released on bail, further referred to as the defendant, appears in court each and every time they are so ordered. B. CREDIT CHECK a. Authorize any of the entities noted herein to request, receive and/or analyze (point or digital) my credit (report) provided by any of the credit bureaus for the purposes of bond approval (prior to execution) or post bond execution for the purposes of unpaid premium collection and/or forfeiture recovery investigations. C. UNPAID PREMIUM a. I will be financially liable for any unpaid premium that the defendant does not or is unable to pay. Further, my payment obligation for unpaid premium is valid even if I do not directly sign the unpaid premium agreement form. I understand that this document herein will equally act as such, should the present (Clause C) be validated by late or nonpayment. I am also aware that any unpaid balance (unpaid premium agreement) associated with this bail bond is owed in its entirely to the Company even if the Defendant noted within this document is sentenced by a judge, incarcerated, released from criminal/motor vehicle liability, passed away, is placed on probation, parole is revoked, and/or moves out of state. Any unpaid balance related to this surety bail bonds is valid regardless of any of the above scenarios and only by full payment fulfillment is such liability ended, I am also aware that any unpaid balance must be paid full no later than 15 months from the date of bond execution and that if there is a consecutive gap of 60 days of non payment, the Company will initiate civil action against me for breach of contract and failure to comply with the unpaid premium agreement herein. D. FORFEITURE RECOVERY EXPENSES a. I will pay for all expenses related to the apprehension, recovery, arrest and/or surrendering efforts conducted by any of the noted legal entities herein, should the defendant forfeit the active surety bail bond. b. If the defendant is not apprehended or surrendered within the time prescribed by Iaw, I agree to pay the full amount of bond, including unpaid premium, attorney fees, court cost, bail recovery/enforcement cost and any other associated Investigation fee. E. RIGHT TO SEARCH a. I give ALL the legal antitlos noted above the right to search any residence of mine or place of residence known to be occupied by me for said defendant should forfeiture occur. F. USE OF TECHNOLOGY a. I authorize the Company to use any available tracking technology for the purpose of learning my physical whereabouts should the the defendant for whom I am providing indemnity for within this contract, falls to appear at court thereby forfeiting bond. G. PREMIUM UNDERSTANDING a. I recognize that once executed, the "PREMIUM" paid for this surety bail bond is NOT refundable.

Indemnitor Signature (Initials) *

Dated: *

PREMIUM FINANCING AGREEMENT AND PROMISSORY NOTE

Dated: *

Bond Amount $ *

Power Number: *

In Trust for: Palmetto Surety Corporation

109 River Landing Drive, Suite 200 Charleston, SC 29492-7595 or Financial Casualty & Surety Inc. 3131 Eastside, Suite 250 Houston, TX 77098

Defendant's Name *

First

Middle

Last

FOR VALUE RECEIVED, I (we), the undersigned Debtor(s), jointly and severally (together and separately), promise to pay to the order of _________ ("Bail Producer") the total sum of _________($_________) owed for the bail bond ("Bond") of ("defendant") noted above, listed within the (Defendant First Name, Middle, Last) opening section. *

PREMIUM BREAKDOWN

NOTE: Amount Received Cannot be Less Than 35% of the Total Regulated Premium Due.

Bail Bond Premium: *

Amount Received: *

Balanced Financed: *

REPAYMENT STRUCTURE

The Debtor(s) agree to pay the "Balance Financed" using the following structure: (1-3) Note: This payment plan cannot extend more than 15 months from the date of this promissory note. (1) Pay the Amount of : *

(2) Where the First Payment is due on *

(3) AND thereafter, the remaining balance to be paid with a frequency of: *

One Time Payment
Weekly
Every Two Weeks
Monthly

(PAYMENTS TO CONTINUE WITH REFERENCED STRUCTURE TILL BALANCE FINANCED IS PAID FULL)

AGREEMENT

(A) I (we), jointly and severally (together and separately), hereby waive presentment, protest and demand, notice of protest, dishonor and nonpayment of this note, and expressly agree that, without in any way affecting my (our) liability under this note. Bail Producer may (i) extend the due date or the time of payment of any payment due under this note, (ii) accept security or partial payments, (iii) release any party liable under this note or any guarantee of this note and (iv) release any security now or later securing this note. This failure of the Bail Producer to enforce any provision of this note, or to declare a default under this note, shall not impair the right of the Bail Producer to declare a default or to strictly enforce the terms of this note. (B) If any portion of this note or any application of such provision shall be declared by a court of competent jurisdiction to be invalid or unenforceable, such invalidity or unenforceability shall not affect any other applications of such provision or the remaining provisions which shall, to the fullest extent, remain in full force and effect. Any amendment or modification of this note must be in writing and signed by both Bail Producer and me (us). (C) I (we) agree to all terms and conditions of this note and acknowledge receipt of a copy of this note. I (we) also agree to pay all collection costs including, without limitation, court costs, reasonable and actual attorneys' fees and expenses, and any penalties and fees permitted by applicable law. (D) All obligations under this note remain in full force and are not terminated, modified or otherwise affected: (i) by revocation of the Bond: (ii) by any change in the status of the Bond or the surety's liability under the Bond; (iii) by any change in the status of court proceedings for which the Bond was posted; or (iv) by any change in whereabouts or status of the Defendant. This note shall become null and void only if all premium amounts and obligations under the Bond have been paid or satisfied, and otherwise, this note shall remain in full force and effect. (E) If any payment is not received by Bail Producer within ten (10) days following its due date or is returned for insufficient funds, stopped or refused for any reason upon presentment to a financial institution, Bail Producer may call all or a portion of the then outstanding balance under this note due and payable, and file suit thereon. (F) The entire amount of the then outstanding balance under this note shall become due and payable immediately under any one or more of the following events: (i) upon Defendant's failure to appear in the court for which the Bond was posted at any time required by such court; or (ii) upon forfeiture of the Bond.

BALANCE IS OWED EVEN IF DEFENDANT IS LATER SENTENCED BY A JUDGE, INCARCERATED, RELEASED FROM CRIMINAL/MOTOR VECHICLE LIABILITY, PASSED AWAY, IS PLACED ON PROBATION, PAROLE IS REVOKED, AND/OR MOVES OUT OF STATE.

DEBTOR #1 *

First

Last

(Dated) *

DEBTOR #2 *

First

Last

(Dated) *

PAYMENT OPTIONS FOR: Bail Out Anytime, LLC Pay by Phone: (860) 995-2067 or (860) 938-1000 Via Mail: Payable to: Bail Out Anytime, LLC, P.O. Box 270593 West Hartford, CT 06127

Phone Numbers

(860) 995-2067

(860) 938-1000

Email

[email protected]

Address

2 Congress St. Suite 1E

Hartford, CT 06114

PAYMENT PLANS AVAILABLE

CREDIT CARDS ACCEPTED

APPLICATION STARTS HERE

1. BIOGRAPHICAL & RESIDENTIAL

2. EMPLOYMENT

3. MOTOR VEHICLE

5. EMERGENCY CONTACTS

AGREEMENT

PREMIUM FINANCING AGREEMENT AND PROMISSORY NOTE

In Trust for: Palmetto Surety Corporation

PREMIUM BREAKDOWN

REPAYMENT STRUCTURE

AGREEMENT

BALANCE IS OWED EVEN IF DEFENDANT IS LATER SENTENCED BY A JUDGE, INCARCERATED, RELEASED FROM CRIMINAL/MOTOR VECHICLE LIABILITY, PASSED AWAY, IS PLACED ON PROBATION, PAROLE IS REVOKED, AND/OR MOVES OUT OF STATE.

PAYMENT OPTIONS FOR: Bail Out Anytime, LLC Pay by Phone: (860) 995-2067 or (860) 938-1000 Via Mail: Payable to: Bail Out Anytime, LLC, P.O. Box 270593 West Hartford, CT 06127

PROMISSORY NOTE

ON DEMAND AFTER DATE, FOR VALUE RECEIVED:

PROMISE TO PAY TO THE ORDER OF BAIL OUT ANYTIME, LLC

DEFENDANT APPLICATION, AUTHORIZATION FORM & AGREEMENT

APPLICATION START HERE

1. BIOGRAPHICAL & RESIDENTIAL

2. PHYSICAL ATTRIBUTES

4. EMPLOYMENT

5. MOTOR VECHICLE

6. IDENTIFICATION

ARREST HISTORY

REFERENCES

Phone Numbers

Email

Address