Application for Appointment
Agent/Agency Information*
Roche Surety, Inc.

(Attach copy of License)

Phone Numbers:

Home:

Counties/Parishes in which to be qualified (please check spelling before requesting):

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(Attach image file of your signature)

Roche Surety, Inc. will perform a criminal and personal background check on all applicants for an appointment. By signing this form, you acknowledge this process.

*You are requesting an appointment with Roche Surety & Casualty Co., Inc. in order to execute bail bonds in your state. Roche cannot authorize you to execute bonds in your state without completing this form with the required appropriate signatures.

Roche Surety & Casualty Company, Inc. is a BBB Accredited Insurance Company in Tampa, FL