Corporate Bail Bond Company Registration {CRF41}

JUSTICE OF THE PEACE COURT FOR THE STATE OF DELAWARE CORPORATE BAIL BOND COMPANY REGISTRATION Name of Bail Bond Company Please select: Address: (The Court cannot accept a P.O. Box as an address. You must provide a full mailing address) Bond Bond and Cash Cash Only City: Telephone Number: Delaware Business License No: City of Wilmington Business License No: City of Dover Business License No: Town of Georgetown Business License No. Delaware Department of Insurance License No. Employer Identification No: (EIN) State: Email Address: Zip Code: (Attach copy) (Attach copy) (Attach copy) (Attach copy) (Attach copy) (Attach copy) Name, Title and Signature of Official Authorized to Appoint Agents: Name: Date: List Agents Authorized to Post Bail: Title: Signature: Authorized Agents to pick up refunds: 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 41 (Issued 12/17/2010) American LegalNet, Inc. www.FormsWorkFlow.com