700 Prospect St. #202 Port Orchard WA 98366 (360) 329-6812

700 Prospect St. #202 Port Orchard WA 98366 (360) 329-6812 www.1111bailbonds.com Application Please register me for the following: ___ 32hr Bail Bond Recovery Agent pre-licensing training - $500 ___ 8hr OC/Taser/Baton- $125

Next Class is March 3 - 6, 2016 in Port Orchard, WA Application and $300 deposit due ON OR BEFORE February 18, 2016

Name:______Address:______City:______State: _____Zip:______Telephone:______E-mail:______Referred by: ______Do you hold a CPL?______Background/training:______

Make all payments payable to "11:11 Bail Bonds". If $300 deposit is paid, balance due on or before March 3rd.

_____My check or money order is enclosed. _____ I will use PayPal for the (send to [email protected]) _____My credit card information is provided. Driver's License #:______State: __ Visa___ MC___ Card#:______Exp Date: ______CVN: ____ I authorize 11:11 Bail Bonds to charge the agreed amount listed above to my credit card provided herein. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.

SIGNATURE: ______DATE:______(initial) All Refund Requests must be made in writing, Full refund if requested by February 25th, after which a 10% fee will be deducted for administrative costs. Refund requests may be emailed or mailed. No refunds will be given after February 25th (credit will be given for future class)