Create Accused Profile

"*" indicates required fields

Step 1 of 2 - Client Details

CLIENT INFORMATION

Client Name*

Upload Profile Image

Accepted file types: jpg, png, Max. file size: 5 MB.

Client SSN*

Date of Birth*

Gender*

Client Home Address*

Street Address Address Line 2 City State ZIP Code

Client Email*

Client Cell Phone*

CHARGES

Charge*

Expected Completion Date*

Account Variables

Variable

IS COURT ORDERED

IS EMPLOYED

IS A SEX OFFENDER

Court Program Information

Program Name

Contact Name

Contact Email

Contact Number

Program Street Address

Program City

Program State

Program Zip Code

Employment Information

Job Title

Employer Phone Number

Employer Email

Company Name

Employer Street Address

Employer City

Employer State

Employer Zip Code

Sex Offender Information

Sex Offender ID

Sex Offender Tier

Distinguishing Marks

Tattoos

Previous Address (Street, City, State & Zip)

Aliases

Tracking Information

Tracking Level

Timezone*

Authorization Agreement for CC Withdraws and Reoccurring Payments

Sign and complete this form to authorize National Pretrial Technology & Services to make monthly reoccurring debit to your credit card listed below. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date each month. Your bank statement will show a withdraw from National Pretrial Technology and Services.

RECURRING PAYMENT AUTHORIZATION

Subscription Length

Today's Date

Card Holder Name*

Card Number*

Expiration Date*

CVV*

Billing Address

Street Address Address Line 2 City State ZIP Code

All Services provided by National Pretrial Technology and Services LLC, hereinafter National Pretrial

I authorize National Pretrial to charge the credit card specified below for the amount indicated on or after the specified date. This authorization applies to the initial installation charge and the facilitation of recurring transactions per the subscription plan selected above for ongoing monitoring services, per the agreed schedule detailed below, ensuring uninterrupted service and convenience. By signing this form, I confirm that I am the authorized user of the credit card entered and have the authority to approve this transaction. I further agree not to dispute the charged amount with my credit card company so long as the transaction corresponds to the terms described in this authorization. This payment authorization is valid for the transaction of goods/services described, for the stated amount, and under the specified billing subscription plan schedule.

Client Payment Authorization*

I AGREE

Signature*

Date