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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 #1

BAIL PRODUCER - [stamp must include name, address, phone no. and license no.]

INDEMNITOR APPLICATION AND AGREEMENT

You, the undersigned indemnitor (“Indemnitor” or “you”), hereby represent and warrant that the following declarations made and answers given are true, complete and correct and are made for the purpose of inducing United States Fire Insurance Company (“Surety”) to issue, or cause to be issued, a bail bond or undertaking for

Defendant:

using power of attorney number(s) (if known),

Power of Attorney

in the total amount of

Dollars ($)

in the Court of

(“Bond”).

1.) INDEMNITOR NAME AND ADDRESS:

RELATIONSHIP TO DEFENDANT:

Relationship to the Defendant:

Indemnitor's Full Name:

Nickname/Alias:

Home Phone #:

Cell Phone #:

Work Phone #:

Email:

Social Media Username:

Current Home Address:

How Long?

Rent or Own?

Rent

Own

Landlord/Mortgage Company:

Former Home Address:

How Long?

Short answer

Rent or Own?

Rent

Own

Landlord/Mortgage Company: