Common use of FINANCIAL STATEMENT/CREDIT INFORMATION Clause in Contracts

FINANCIAL STATEMENT/CREDIT INFORMATION. Cash On Hand $ Cash In Bank $ Real Estate Value $ Real Estate Mortgage $ In Whose Name Is Title Monthly Salary Or Wages $ All County Bail Bonds, Inc. 0000 X. Xxxxxxxx Xxxxxx, #000X Xxxx Xxxxxxx, XX 00000 (000) 000-0000 BAil Producer [Include: name, address, phone no. and license no.] FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. i Agree to the terms set forth on All 4 PAges of this Agreement. Signed, Sealed And Delivered at , this day of , 20 WITNESS INDEMNITOR Sign Sign Print Print Page 2 of 4 White – PSriogdnuBcoerthcCooPypi•esy;ePllrooWdu–cinedr eCmonpityor coPy ASC-STD-002 (12/13) THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly appointed independent bail producer referenced below (“Producer”).

FINANCIAL STATEMENT/CREDIT INFORMATION. Cash On Hand $ Cash In Bank $ Real Estate Value $ Real Estate Mortgage $ In Whose Name Is Title Monthly Salary Or Wages $ All County Bail Bonds, Inc. 0000 X. Xxxxxxxx Xxxxxx, #000X Xxxx Xxxxxxx, XX 00000 (000) 000-0000 BAil Producer [Include: name, address, phone no. and license no.] FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. i Agree to the terms set forth on All 4 PAges of this Agreement. Signed, Sealed And Delivered at , this day of , 20 WITNESS INDEMNITOR Sign Sign Print Print Page 2 of 4 White –SPirgondBucoethr cCooPpyie•s;yeInldloeWmn– PSriogdnuBcoerthcCooPypi•esy;ePllrooWdu–cinedr eCmonpityor iintodreCmoniptyor coPy ASC-STD-002 (12/13) THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly appointed independent bail producer referenced below (“Producer”).

FINANCIAL STATEMENT/CREDIT INFORMATION. Cash On Hand $ Cash In Bank $ Real Estate Value $ Real Estate Mortgage $ In Whose Name Is Title Monthly Salary Or Wages $ All County Xxxx Bail Bonds, Inc. 0000 X. Xxxxxxxx Xxxxxx Xxxxxx, #000X Xxxx XxxxxxxSuite 101A West Palm Beach, XX FL 00000 (000) 000-0000 BAil Producer BAIL PRODUCER [Include: name, address, phone no. and license no.] FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. i Agree to the terms set forth on All I AGREE TO THE TERMS SET FORTH ON ALL 4 PAges of this AgreementPAGES OF THIS AGREEMENT. Signed, Sealed And Delivered at , this day of , 20 WITNESS INDEMNITOR Sign Sign Print Print Page 2 of 4 White WHITE –SPiRgOnDBUCoEthR CCOoPpYie•s;YIEnLdLOeWmn– PSriogdnuBcoerthcCooPypi•esy;ePllrooWdu–cinedr eCmonpityor coPy iINtoDrECMoNIpTyOR COPY ASC-STD-002 (12/13) THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly appointed independent bail producer referenced below (“Producer”).

FINANCIAL STATEMENT/CREDIT INFORMATION. Cash On Hand $ Cash In Bank $ Real Estate Value $ Real Estate Mortgage $ In Whose Name Is Title Monthly Salary Or Wages $ All County Xxxx Bail Bonds, Inc. 0000 X. Xxxxxxxx Xxxxxx Xxxxxx, #000X Xxxx XxxxxxxSuite 101A West Palm Beach, XX FL 00000 (000) 000-0000 BAil Producer BAIL PRODUCER [Include: name, address, phone no. and license no.] FLORIDA RESIDENTS Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. i Agree to the terms set forth on All I AGREE TO THE TERMS SET FORTH ON ALL 4 PAges of this AgreementPAGES OF THIS AGREEMENT. Signed, Sealed And Delivered at , this day of , 20 WITNESS INDEMNITOR Sign Sign Print Print Page 2 of 4 White WHITE – PSriogdnuBcoerthcCooPypi•esy;ePllrooWduPSRigODnUBCoEtRhCCOoPYpi•esY;EPLLrOoWdu–cinedr eCmonpityor coPy cINerDECMoNpITyOR COPY ASC-STD-002 (12/13) THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly appointed independent bail producer referenced below (“Producer”).