Application

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Race *

Email *

Sex *

Date of Birth *

Second Contact *

Phone *

Payment Made *

Location *

I acknowledge that 24/7 GA GPS, INC has installed a GPS monitor as a condition of release or probation. *

I am responsible for paying for any damage or loss of the device if the participant refuses or is otherwise unable to pay. This also applies if the participant gets rearrested and the law enforcement agency cuts off the monitor. If the wrist band or ankle monitor is cut/taken off the fee is $150.00. There is an additional charge if 24/7 GA GPS, INC or Talitrix call centers has to contact the participant. $25 per occurrence. Some of the common reasons are: Victim/Exclusion Zone, Inclusion Zone, (Work/Home Curfew), Wristband or Ankle Tamper Violation, Failure to Maintain a Charge of Device *

I understand that the GPS device is water resistant, not waterproof. It can be worn in the shower, but not submerged in water. The charger itself is not water resistant and cannot get wet. Damage to the band or charger can result in a replacement fee of $50.00 for the charger and $500.00 for the band. *

I owe for services rendered regardless of the outcome of the charges (dismissal, acquittal, plea or sentence). *

I must pay an installation fee of $150 and a monitoring fee 30 days in advance at a daily rate of $10.00. The payments are do on the monthly anniversary of the installation. Payments must be set put for automatic payment withdrawals, unless different arrangements are made in advance. *

I agree to keep a current credit card on file with 24/7 GA GPS, INC (unless otherwise approved) and I give authorization to charge my card for any damage/other costs if I fail to pay them. *

I have reviewed this form with an agent of 24/7 GA GPS, Inc or online at www.247GAGPS.com and fully understand the instructions regarding the use of the GPS band and acknowledge that I am responsible for safeguarding the device. *

Guarantor Phone *

Guarantor Address *

Address Line 1

Address Line 2

City

State

Zip Code

Guarantor Email *

Guarantor Name *

First

Last

Guarantor's Signature

Clear Signature

Date Signed

Application

Application

Office

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