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Charleston's oldest full service bonding agency

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United States Fire Insurance Company (Surety)

11490 Westheimer Rd., Suite 300 • Houston, TX 77077

P.O. Box 2807 • Houston, Texas 77252-2807

(713) 954-8100 • (713) 954-8389 FAX

Email: CourtNotices@cfins.com

Form #2

MARITAL STATUS/CHILDREN

Pick One:*

Married

Divorced

Separated

Widowed

Single

Cohab

Spouse/girl/boyfriend's Name (First, Middle and Last):*

How Long Married/together?*

Address (if different):

Email:*

Home Phone # (if different):*

Cell Phone #:*

Social Security #:

Occupation:

Employer:

How Long?

Supervisor's Name:

Work Phone #:

Child 1's Name, Date of Birth, School/Employer, and other Parent's Name:

Child 2's Name, Date of Birth, School/Employer, and other Parent's Name:

VEHICLE

Describe your Vehicle:

Year:

Make:

Model:

Color:

Plate #:

State:

Where Financed?

Amount Owed?

Insurance Agent's Name:

Insurance Agent's Phone #:

ARREST INFORMATION

Date of Arrest:*

Booking Name (if different):

Arresting Agency:*

Jail Location:*

Booking #:*

Charges:*

Previous Arrest (Charges, Date, and Where):*

Previous Arrest (Charges, Date, and Where):

Pending Charges in Other Counties:*

Are You on Parole/Probation?*

Yes

No

Parole/probation officer name and phone #:

Are you now under any bond?*

Yes

No

Have you ever failed to appear in court?*

Yes

No

Bonded before by:

When?

ATTORNEY

Name and Firm:

Phone #:

Email:

Amount of retainer paid $:

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