Credit Card Authorization Form

STOP!

READ THE FOLLOWING PRIOR TO FILLING OUT THE FORM

If you have ANY questions call us IMMEDIATELY at

602-258-4488

Please fill out the authorization form below. In order to process your credit card for any bail bond transaction, we will need a valid credit card authorization form submitted. In order to protect our clients from fraud we reserve the right to refuse service to anyone not meeting all of the requirements as defined below including but not limited to: legible copies of the client’s credit card, drivers license and signature. The credit card and driver license names must match each other exactly. The credit card must have a valid signature on the back of the card that matches the signature of the driver license.

DO NOT FILL OUT THIS CREDIT CARD AUTHORIZATION WITHOUT PRIOR APPROVAL.

Bonds can only be posted during the times set forth at the jail. Please make sure you FULLY understand the terms of the bond agreement and the process that it takes to have a bond processed and an inmate released. It is your responsibility to understand this prior to paying for the bond. We will be more than happy to answer any and all questions you may have about the bail bond process

CREDIT CARD AUTHORIZATION

Please complete all fields to authorize us to charge your credit card for the AGREED UPON amount.
  • INMATE INFORMATION

  • Date of BirthBooking No 
    *Must provide at least a Booking Number or Date of Birth
  • CREDIT CARD INFORMATION

  • *Name must match the credit card & driver's license EXACTLY
  • This dollar amount must come from us. Please enter the agreed upon charge amount.
  • Accepted file types: jpg, gif, png, pdf.
    You must upload a copy of your driver license held next to your face for security purposes.
  • Accepted file types: jpg, gif, pdf, png.
    You must upload a legible copy of the front of your credit card. It must be a card with the name that matches the driver license.
  • Accepted file types: pdf, jpg, gif, png.
    You must upload a legible copy of the back of your credit card. It must be a card with a signature that matches the one used on our form. Unsigned cards will not be accepted.
  • Use 1234-1234-1234-1234 FORMAT
  • Please input your credit card expiration date in month/year format such as 02/14
  • 3 or 4 digit Security code on front or back depending on type of Card. AMERICAN EXPRESS IS ON FRONT and 4 digits. All other cards are 3 digits on the back of the card.
  • Section Break

  • This field is for validation purposes and should be left unchanged.