TENNESSEE BONDING CREDIT CARD AUTHORIZATION FORM

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BONDS INFORMATION

Today’s Date:

Full Legal Name of Defendant

Defendant Date of Birth

City / County / State

Bond Amount

BILLING INFORMATION

Cardholder Name

Card Billing Address

Address Line 1

City

State

Zip Code

Email Address

Phone

CARD INFORMATION

Credit Card Number

Expiration Date

CVV

Amount of Today's Charge

Dollars $

Card Type

Visa
Mastercard
Discover
Amex

I hereby authorize the charging(s) of my credit card as indicated.

By signing this credit card authorization form, you are also granting us permission to charge your card and the use of your signature on file for any additional charges that may arise in the future pertaining to your obligation/s as an indemnitor for this bond amount. The undersigned accepts and agrees to all of the bond terms and financial obligations as stated in the bail bond indemnity agreement and acknowledges that they are part of this credit card authorization form for future charges.

I agree to indemnify and hold harmless the surety or its agent for all losses in connection with this bond(s) not otherwise prohibited by law.

I HAVE READ AND AGREE TO ALL OF THE ABOVE.

Card Holder's Signature

Clear Signature