Please provide the following information.

INFORMATION FORM

Personal Information

Name(Required)

Nick/Street/Stage Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

Name of Apt. Complex

Place of Birth

Home Phone

Cell Phone

Cell Carrier

Email Address

DOB(Required)

SS#

DL# or ID#

State (DL/ID)

Race

Sex

Age

Height

Weight

Hair

Eyes

List Scars/Marks/Tattoos

Employment Information

Employer

Phone #

How Long

Position

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Family Information

Spouse

Spouse Cell Phone

Spouse Employer

Spouse Employer Phone

Name of Children

Their School

Ex Spouse

Ex Spouse Phone

Vehicle & History

Auto Year

Make/Model

Color

Plate

Have you ever been bonded before?

Yes

If yes, which company?

Are you on:

Probation

Parole

Officer's Name

Family Members

Family Member 1 Name

Relationship

Address

Home #

Other #

Family Member 2 Name

Relationship

Address

Home #

Other #

Family Member 3 Name

Relationship

Address

Home #

Other #

Other References

Reference 1 Name

Relationship

Address (If Known)

Home #

Other #

Reference 2 Name

Relationship

Address (If Known)

Home #

Other #

Reference 3 Name

Relationship

Address (If Known)

Home #

Other #

FAILURE TO NOTIFY THIS OFFICE OF ANY AND ALL CHANGES ON THIS FORM JUSTIFIES REVOKING YOUR BOND AND ISSUING A WARRANT FOR YOUR ARREST.

Signature(Required)

Type your full name to sign

Name(Required)

Date(Required)

RONNIE D. LONG BAIL BONDS
6004 AIRPORT FWY. FT. WORTH, TX 76117
OFFICE: 817-834-9894 • METRO 817-498-2000

Please complete the following Promissory Note.

PROMISSORY NOTE

For a valuable consideration, the receipt and sufficiency of which is hereby acknowledged, we or either of us, as principals, promise to pay to the order of RONNIE D. LONG, in the city of Fort Worth, Tarrant County, Texas, the actual costs incurred in the resolution of a forfeiture on the below referenced bail bond, with interest thereon at the rate of ten percent (10%) per annum from date until paid. These costs include, but are not limited to, Bond Forfeiture Judgment, Court Costs, Extradition Costs, and Recovery Costs.

This note is due and payable in full as follows at the election of the holder. Without demand or notice upon the forfeiture of the bail bond(s) of

Name of Defendant (Bail Bond of)(Required)

Case No(s).(Required)

and on demand upon one maker of this note shall be sufficient notice as a demand upon all said makers, whether made orally or in writing.

It is expressly agreed and provided that upon default in the punctual payment of this notice when it becomes due and payable (Punctual payment as provided above) then an additional sum as reasonable collection fees shall be added to said principal and interest, and further, if the same is placed in the hands of an attorney for collection, then the undersigned agree and promise to pay an additional sum as reasonable attorney's fees, which in no event shall be less than forty percent (40%) of the principal and interest then owing.

It is expressly agreed and provided that after this note becomes due and payable, the holder hereof may agree with any of us to accept partial payments in installments and such agreement or payments shall not affect the liability of the other makers who shall remain bound for the payment hereof. Venue of any action on this note shall be in Tarrant County, Texas.

It is expressly agreed and provided that if suit is necessary for collection of this note, the holder hereof may sue any or all of the undersigned and any party not served with citation therein shall not be released but shall remain bound for the payment thereof.

Principals hereby acknowledge receipt of a copy of this Promissory Note and have read and understood the provisions of it before signing it.

DATED THIS THE(Required)

PRINCIPAL (PRINT NAME)(Required)

EMAIL ADDRESS

ADDRESS(Required)

CITY/STATE/ZIP(Required)

DATE OF BIRTH(Required)

DRIVER'S LICENSE #(Required)

SOCIAL SECURITY #(Required)

PLACE OF EMPLOYMENT

WORK PHONE #

CELL PHONE #

SIGNATURE(Required)

Type your full name to sign

WITNESSED BY

DATE

Please read and sign the following notice.

NOTICE REGARDING ALIENS WHO MAKE BOND

An alien incarcerated for criminal charges in the United States may be subject to detention and deportation by the United States Government. Detention and deportation are particularly likely for aliens who are in the United States illegally.

Bonds for criminal charges have no effect on detention and deportation proceedings or possibilities. An alien who makes bond on all state criminal charges may, in some cases, never obtain release from jail before disposing of his or her criminal case. Furthermore, he or she may be subject to deportation at any time.

An alien making a bail bond and his or her bondsman may remain liable on the bond when the alien fails to appear for court due to deportation from the United States.

Finally, it should be noted that anyone who encourages or aids an alien to enter or re-enter the United States may be subject to criminal prosecution, as may anyone who encourages or aids an alien to intentionally or knowingly fail to appear for court proceedings as promised in a bail bond.

NOTIFICACIÓN REFERENTE A PERSONAS INDOCUMENTADAS QUE UTILIZAN FIANZAS

Una persona indocumentada que haya sido encarcelada por cargos criminales dentro de los Estados Unidos, puede ser detenida y deportada por el gobierno federal. La detención y deportación son muy probables para aquellas personas que estén de manera ilegal en los Estados Unidos.

Las fianzas para cargos criminales no tienen efecto alguno en los procedimientos o posibilidades de detención y/o deportación. Una persona indocumentada que utiliza una fianza en cualquier cargo criminal podría, en algunos casos, no ser puesta en libertad antes de que se completen los procedimientos de su caso, e incluso, podría ser deportada en cualquier momento.

Una persona indocumentada que utiliza una fianza y su afianzador o afianzadora, pueden ser hechos responsables de cubrir la fianza cuando la persona indocumentada no se presente ante la corte debido a que haya sido deportada.

Finalmente, se debe aclarar que cualquier persona que ayuda o incentiva a que una persona indocumentada ingrese o reingrese de manera ilegal a los Estados Unidos, puede ser perseguida criminalmente. De la misma manera, también se puede perseguir criminalmente a cualquier persona que incentiva o ayuda a que una persona indocumentada, con conocimiento o de manera intencional, no se presente a corte de acuerdo a lo prometido en su fianza.

BONDSMAN / AGENT SIGNATURE(Required)

BONDSMAN / AGENT NAME(Required)

DATE(Required)

CLIENT / RECIPIENT SIGNATURE(Required)

CLIENT / RECIPIENT NAME(Required)

DATE(Required)

RONNIE D. LONG BAIL BONDS
6004 AIRPORT FWY. FT. WORTH, TX 76117
OFFICE: 817-834-9894 • METRO 817-498-2000

Please read the following rules carefully and initial where indicated.

BOND RULES

YOU MUST OBSERVE THE FOLLOWING RULES, OR YOUR BOND MAY BE REVOKED.

(please initial next to the number upon reading rules)

Initial #1(Required)

1. Your check in number 817-834-9894. You must check in with my office, by phone, on Wednesday of each week between 8:30a.m. and 5:30p.m. until your case is disposed of.

Initial #2(Required)

2. You must appear in court as required. Failure to do so will result in a warrant for your arrest being issued, also, subject to a possible penalty of up to 20 years imprisonment and/or a fine of $10,000.00 for bond jumping.

Initial #3(Required)

3. You must notify my office of any changes in address, phone, employment, etc. I cannot stress enough how important it is to keep your information updated.

Initial #4(Required)

4. You must retain an attorney and then inform my office of the attorney's name, address, and phone number. (If already retained, please list)

ATTORNEY'S NAME

PHONE #

ADDRESS / CITY / STATE / ZIP

Initial #5(Required)

5. You must call my office when you receive notice of any and all court settings.

Initial #6(Required)

6. If you fail to appear for court, there will be additional fees for which you will be responsible.

I am truly concerned about your welfare. If you should have any problems or questions, please do not hesitate to call my office. My staff and I are willing to help you in any way that we can but in order for us to help you, you must abide by all of the above mentioned rules.

I HAVE READ THE ABOVE RULES AND FULLY UNDERSTAND MY OBLIGATION TO RONNIE D. LONG.

SIGNATURE(Required)

Type your full name to sign

NAME(Required)

DATE(Required)

RONNIE D. LONG BAIL BONDS
6004 AIRPORT FWY. FT. WORTH, TX 76117
OFFICE: 817-834-9894 • METRO 817-498-2000

PLEASE READ CAREFULLY

CREDIT CARD AUTHORIZATION AGREEMENT

PLEASE READ CAREFULLY

I, (Name of Undersigned)(Required)

the undersigned owner of the credit card submitted, hereby request Ronnie D. Long Bail Bonds to obtain an approval...

in the amount of $(Required)

for the purpose of paying... for posting the bond(s) for (Principal Name)(Required)

hereinafter called Principal.

I understand that this Bonding Company is charging my credit card and is doing so at my request.

I also understand that any collateral charged on my credit card will be refunded as a credit to my credit card account within thirty days after I furnish written proof to the Bonding Company that the criminal case(s) in which the Principal's bail bond(s) are posted has been disposed of, unless I have outstanding financial obligations to the Bonding Company or unless the Bonding Company has outstanding contingent liabilities remaining with respect to the bond(s) for which the collateral was pledged. In the case of those events, I understand that the collateral will not be refunded to my credit card account until thirty days after final resolution of those financial obligations to the Bonding Company or until thirty days after all contingent liabilities are resolved, whichever is later.

CREDIT CARD NUMBER(S)(Required)

SECURITY CODE(S)(Required)

EXPIRATION DATE(S)(Required)

BILLING ADDRESS OF CARDHOLDER(Required)

Street Address Address Line 2 City State ZIP Code

DRIVER'S LICENSE #(Required)

State

Please send a copy of your Driver’s License (front only) and the Credit Card (front and back) with this authorization.

Signed On(Required)

CARDHOLDER SIGNATURE(Required)

CARDHOLDER NAME(Required)

RONNIE D. LONG BAIL BONDS
6004 AIRPORT FWY. FT. WORTH, TX 76117
OFFICE: 817-834-9894 • METRO 817-498-2000

Please complete the following Payment Agreement.

PAYMENT AGREEMENT

For a valuable consideration, the receipt and sufficiency of which is hereby acknowledged, that we or either of us as principals promise to pay to the order of RONNIE D. LONG BAIL BONDS, at his office located at 6004 Airport Frwy., Ft. Worth Texas 76117, the sum of:

Total Amount ($)(Required)

Which is the balance owed on the bond or bonds of (DEFENDANT)(Required)

The debt is to be paid in increments as follows:

Increments of ($)(Required)

Per (e.g. Week, Month)(Required)

Beginning Date(Required)

and continuing until the entire amount is satisfied.

It is expressly agreed and provided that upon default in the punctual payment of this debt as it becomes due (punctual payment shall mean within five days from the date the payment is due) the bonds could be dropped and an additional sum may be added for collection fees.

It is expressly agreed and provided that if a lawsuit is necessary for collection of this note, the holder may sue any or all of the undersigned parties and any party not served with citation herein shall not be released but shall remain bound for the payment thereof.

Principals hereby acknowledge receipt of a copy of this Payment Agreement and have read and understand the provisions of same before signing it.

DATED THIS(Required)

DEFENDANT (Signature/Name)(Required)

CO-MAKER (Signature/Name)

HOME ADDRESS(Required)

HOME PHONE #

CELL PHONE #

PLACE OF EMPLOYMENT

WORK ADDRESS

WORK PHONE #

SOCIAL SECURITY #(Required)

DRIVER'S LICENSE #(Required)

DATE OF BIRTH(Required)

RONNIE D. LONG BAIL BONDS
6004 AIRPORT FWY. FT. WORTH, TX 76117
OFFICE: 817-834-9894 • METRO 817-498-2000

INFORMATION FORM

Personal Information

Employment Information

Family Information

Vehicle & History

Family Members

Other References

PROMISSORY NOTE

NOTICE REGARDING ALIENS WHO MAKE BOND

NOTIFICACIÓN REFERENTE A PERSONAS INDOCUMENTADAS QUE UTILIZAN FIANZAS

BOND RULES

CREDIT CARD AUTHORIZATION AGREEMENT

PAYMENT AGREEMENT

Need Help with Bail Bonds? We’re Here for You!

(817) 834-9894

Address

Email

Hours Of Operation