Select Jail Location - Intake Form

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Defendant Name

Your Name

You Phone Number

Your Email

Defendant's Information

Name of Person in Jail

Defendant's Date of Birth

Bail Information

Bail Amount

Arrest Date

Booking Number

Premium

How much funds are available toward the bail premium?

Your Information

Your Name

Your Date of Birth

Social Security Number

Driver's License #

Your Street Address

Your City

Your State

Your Zip Code

Your Phone Number

Your Email

ID Upload

Upload ID (Drivers License, Passport, or Any State Issued ID)

Employment

Employer Name

Length Of Employment

Phone Number

Street Address

City

State

Zip Code

Privacy Disclosure

This privacy policy has been compiled to better serve those who are concerned with how their ‘Personally identifiable information’ (PII) is being used online. PII, as used in US privacy law and information security, is information that can be used on its own or with other information to identify, contact, or locate a single person, or to identify an individual in context. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website.

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Bail agent record of request by family member to solicit arrestee (§2079.1, title x, cac)

I authorize the Surety and its producers, agents, and representatives to contact me and or the arrestee (defendant) for solicitation of bail.