Individual Bail Agent Registration {41IND}

JUSTICE OF THE PEACE COURT FOR THE STATE OF DELAWARE INDIVIDUAL BAIL AGENT REGISTRATION Name of Bail Agent: Address: (The Court cannot accept a P.O. Box as an address. You must provide a full mailing address) City: State: Zip Code: Telephone Number: Please select: Delaware Business License No: Municipal Business License No: Bond Email Address: Bond and Cash Cash Only (Attach copy) (Attach copy) (Attach copy) (Attach copy) Delaware Department of Insurance License No. Surety Power of Attorney: Picture ID: (Attach copy) If any of the above information is missing or incomplete, the registration will be returned to the applicant. I hereby agree to notify the Court in writing within ten (10) business days of any changes to this document. Signature and Title JP Criminal Form 41IND (Issued 12/17/2010) American LegalNet, Inc. www.FormsWorkFlow.com JP Criminal Form 41IND (Issued 12/17/2010) American LegalNet, Inc. www.FormsWorkFlow.com