PAYMENT AGREEMENT
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
I have employed the services of AA- Action Bail Bonds to secure my release. I have been charged with
(offense charged with)
and was placed in the Rusk County jail. My bond(s) was set at:
(total amount of bonds)
and I agreed to pay AA- Action Bail Bonds a total fee of $
(total fee for bail)
I have paid AA-Action Bail Bonds
(down payment paid)
on date
-
Month
-
Day
Year
Date
I will make
Please Select
weekly
monthly
bi-monthly
one
(payment frequency - select from dropdown)
payment(s) to AA- Action Bail Bonds, beginning on the date below and continuing until AA- Action Bail Bonds is paid in full. I understand that all payments must be made for AA-Action Bail Bonds to maintain my bond.
-
Month
-
Day
Year
Date
Payee
Co-borrower if required
Continue
Continue
Should be Empty: