Payment Form Defendant's Name* First Last Payment Type*New BondPayment on AccountAgent*Select an AgentJanssen AaronNeil BennerDonny CatesDave DoyenDJ DoyenTracy EllingsonTom GoffDonovan HarrisStephanie HenningsKarl HylleJay HyvareJohn KischGay LaRoqueLeisa MageeScott MakensMike NeillMary NonakaAlberto PatinoBeth SmithChris WefelJonathon WetzbargerPhone*Email* Payment Amount*Please enter a number from 1 to 10000.Enter an amount ($1.00 - $10,000.00)Total3% fee will be added to your paymentCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please Initial*I hereby authorize Bail Bonds Doctor, Inc. to charge my credit card in the amount listed above as "total" listed above. I agree that I will not initiate any dispute on this charge for the reason of "No Cardholder Authorization"Please Initial*I agree that this authorization remains in full force and effect until such time as the bond obligation referred to herein is fully exonerated or discharged. I understand this credit card may be charged for any future invoice for any and all premium and/or forfeiture costs associated with this/these bail bonds.Signature*Full Name Signed*Receipt Send me a receipt
