CO-SIGNER (GUARANTOR) APPLICATION

CO-SIGNER (GUARANTOR) APPLICATION
Name

First NameLast Name
AKA:
Relationship to defendant:
Are you currently out on bond?
Are you currently on probation?
If yes, where and what are the charges?
Are you a co-signer on another bond?
If yes, who and where?
Co-signer information:
Birth Date

MonthDayYear
Date
Place of birth:
Social Security Number:

License Information:
DL#:License number* Issuing state: State* Exp:mm/dd/yyyy*
Sex:   Male   Female*
Race:blanks Height: blank Weight:  lbs*
Eyes:   colocolor*    Hair color:   color*
ID marks, scars, tattoos:
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at current address:
I own my home:
If you lease or rent your home, landlord's name:
Landlord's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email
example@example.com
Social Media Accounts
Facebook:
Twitter:
Instagram

Employment History:
Current Employer:
Time at Current Employer:
Job Title:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gross pay:
Based on pay received:
Previous employer
Time at previous employer
Job title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Automobile Information:
Make: blanks Model: blank Year:
Color:      Tag number:   color
Lien holder:   color Phone #:      Phone Number*
Spouse:
Name

First NameLast Name
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's automobile information:
Make: blanks Model: blank Year:
Color:      Tag number:   color
Lien holder:   color Phone #:      Phone Number
Current Employer:
Employers Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List five (5) personal references:

(*Cannot be a spouse or a co-signer*)
Reference 1:

First NameLast Name
Relationship:
Reference 1 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 1 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2:

First NameLast Name
Relationship:
Reference 2 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3:

First NameLast Name
Relationship:
Reference 3 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference 4:

First NameLast Name
Relationship:
Reference 4 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 4 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference 5:

First NameLast Name
Relationship:
Reference 5 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 5 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.

Consent to Release Personal Information
I hereby authorize a review if and full disclosure of all records concerning myself to any duly authorized agent of 1st Choice Bonding Co, Inc, or to any authorized agent of a criminal justice agency or any private agency upon request of 1st Choice Bonding Co. Inc.whether the said records are of public, private, or confidential nature.

The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institutions; financial or credit institutions, including records of loans, the records of commercial or retail credit agencies (including credit reports and/or rating) and financial statements and records wherever filed; medical and psychiatric treatment and/or consultation including hospitals, clinics, private practitioners, and the U.S. Veteran’s Administration; employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me and the records and recollections or attorneys
at law, or of other counsel whether representing me or another person in a case, either criminal or civil, in which I presently have or have had an interest.

I understand that any information obtained by a personal history background investigation, which is developed directly or indirectlyin whole or in part, upon this release authorization, will be considered in determining the accuracy of the application submitted to 1st Choice Bonding Co. Inc., I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information; and I hereby release said person(s) from many and all liability, which may be incurred as a result of furnishing such information. I also agree to pay any and all charges or fees concerning this request and can be billed for such charges at the below listed address.

A photo copy of this release form will be valid as an original thereof, even though the said photocopy does not contain an original writing of my signature.
Co-signer

First NameLast Name
Co-signer Signature
Date:

MonthDayYear
Date
Defendant

First NameLast Name
Defendant Signature
Date:

MonthDayYear
Date
Defendant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Defendant Date of Birth:

MonthDayYear
Date
Defendant Social Security Number:
Should be Empty: