Indemnitor / Co-Signer Application

Fill out the form completely. False information may disqualify your application.

NOTE: False information, omissions or misrepresentation of facts called for in this application may disqualify your application. Fill out form in its entirety. * indicates required fields.

As an Indemnitor (Co-Signer) you are financially responsible for ensuring the defendant appears at all court dates. Questions? Call (919) 834-2288.

INDEMNITOR / CO-SIGNER PERSONAL INFORMATION

First Name *

Middle Name

Last Name *

Date of Birth *

Social Security Number *

Sex *

Race

Relationship to Defendant *

Home Phone

Cell Phone *

Email Address

CURRENT ADDRESS

Street Address *

City *

State *

ZIP Code *

Residence Type *

Years at Current Address *

EMPLOYMENT INFORMATION

Employer Name

Occupation / Job Title

Employer Street Address

Employer City

Employer State

Employer Phone

Years Employed

Monthly Income

FINANCIAL INFORMATION

Own Real Property?

Property Value (if owned)

Mortgage Balance (if owned)

Bank Name

Checking Account Balance

Savings Account Balance

DEFENDANT INFORMATION

Defendant First Name *

Defendant Last Name *

Defendant Date of Birth

County of Arrest *

Bond Amount *

Charge Description *

ADDITIONAL INFORMATION

Have you ever been arrested?

Additional Information / Comments

By submitting this form you authorize Golder Bail Bonds Inc. to release all credit data necessary to complete this process. You understand your responsibilities as an Indemnitor (Co-Signer) on a bail bond for the Defendant.

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