Georgia Association
Of Professional Bondsmen, Inc.
196 Peachtree Street,
S.W.
• Atlanta, Ga 30303
Phone (404) 523-0389 • Fax (404) 659-4201
Bail Recovery Application
Agent
Name______________________________________________________________________________
Address__________________________________________________________________________________
City _______________________________________________ State __________ ZIP ________________
Phone _______________________________________ Fax
________________________________________
E-Mail* _____________________________________
Website* ____________________________________
(*optional)
Height _______'_______" Weight __________ lbs. D.O.B. _______ /_______ /_______
Driver License #
______________________________________ State__________ Exp. ______ /_-______
Firearm Permit #
______________________________________ Exp. _______ /_______ /_______
___________________________________________
___________________________________________
Agent Signature Date
Agent (Print Name)
___________________________________________
___________________________________________
Registrant
Signature Date
Registrant (Print Name)
___________________________________________
___________________________________________
Bonding Company
Name Contact Phone
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