Bailbonds Application and Agreement

You, the undersigned Defendant (“Defendant” or “you”), hereby represent and warrant that the following declarations made and answers given are true, complete and correct and are made for the purpose of inducing Bankers Insurance Company (“Surety”) to issue, or cause to be issued, bail bond(s) or undertaking(s) for you (singularly or collectively the “Bond”), using power of attorney number(s) (if known) , in the total amount of Dollars ($ ) in the Court of .