MAKE A REFERRAL FOR BAIL ASSISTANCE | Orange County Bail Bond Justice Project

Person Making Referral

Your Name *

First

Last

Relationship to Person Needing Bail *

Your Phone Number *

Your Email *

Your Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you prefer text, phone call, or e-mail? *

Are you able to assist with greeting/transportation after bail is posted? *

Yes
No

Information on Person Being Bailed Out (Fill out to the best of your ability.)

Full Legal Name (If Known) *

First

Last

Email Address

Phone Number

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Physical Address (Place of Last Residency)

Address Line 1

Address Line 2

City

State

Zip Code

Has the person consented to be bailed out? *

Yes
No

If yes, how did you obtain permission?

Case Information

Case Number (If Known)

Date of First Appearance Hearing (If Known)

Bail Amount (We Post a Total Bail Up to $5,000)

Date of Arrest (If Known)

Did the arrest occur in Orange County?

Yes
No

Was the charge (and any underlying charges) for Orange County, North Carolina?

Yes
No

Name of Public Defender Attorney Appointed? (If Known)

Next Court Date (If Known)

Does the person have any holds in any other counties or states?

Yes
No

Does the person have multiple, recent Failures to Appear in court? (Note any special concerns in the field below, if any.)

Yes
No

If this is a domestic violence case, have protective orders been taken out against the individual on this case or prior cases?

Yes
No

Has there been a violation of a protective order? (Note any special concerns in the field below, if any.).

Yes
No

Special Concerns (Please list any special concerns we should be aware of.)

Anything else we should know?