|
Bondsman's E-mail
|
| |
[email protected]
|
|
Bondsman
|
| |
Erica Davis
|
|
Agreement Date
|
| |
09/23/2025
|
|
Enrollee's Full Name
|
| |
LAQUENTIN BENDER
|
|
Guarantor's Full Name
|
| |
LAQUENTIN BENDER
|
|
Please Choose a Device
|
| |
|
|
Daily Rate
|
| |
$10.00
|
|
# of Days to Charge
|
| |
10
|
|
Daily Rate Total
|
| |
$100.00
|
|
Enrollment Fee
|
| |
$50.00
|
|
Replacement Fee
|
| |
$0.00
|
|
Transaction Fee
|
| |
$0.00
|
|
Total Owed Today
|
| |
$150.00
|
|
Add a Credit Card Authorization
|
| |
No
|
|
|
SEND Guarantor THEIR CONTRACT
|
| |
Yes
|
|
Guarantor's Email Address
|
| |
[email protected]
|
|
Guarantor's Phone #
|
| |
+14703062685
|
|
|
Send Enrollee Their Contract
|
| |
No
|
|
Order
|
| |
| Product |
Qty |
Unit Price |
Price |
|
No
|
1 |
$0.00 |
$0.00 |
| |
Sub Total |
$0.00
|
| |
Total |
$0.00 |
|
