ABC Bonding of Texas

Credit Card Authoziation Form

I hereby give permission to All State Bonds, Inc. Dba ABC Bonding of Texas to charge my credit card for the following bond(s) or Insurance Policy.

Business/Individual Name as it Appears on the Application	*
Bond Type / Policy No. ( if Avialable )
Telephone	*
Name as it Appears on the Card	*
Card Type	*	Visa Mastercard Discover American Express
Credit Card Number	*
Expiration Date	*
Billing Address	*
City	*
State	*
Zip Code	*
Amount to Be Charged	*
Enter Security Code	*
Disclosure - IN CONSIDERATION of the execution of such bond, and in compliance with a promise of the undersigned made prior thereto, the undersigned individually hereby agree upon issuance of such bond, for themselves, their personal representatives, successors and assigns, jointly and severally, as follows: 1. That the provided information is true and correct. 2. To reimburse Surety Company ("Surety") upon demand for all payments made for and to indemnify Surety from: a) all loss, contingent loss, liability and contingent liability, claim, expense, including attorneys' fees and claims adjusting fees, for which Surety shall pay, become liable or shall become contingently liable by reason of such suretyship, whether or not Surety shall have paid same at the time of demand; and b) to pay Surety an advance premium for the first year or a fractional part thereof that is fully earned and to pay annually thereafter such annual premium for suretyship as is billed until satisfactory evidence of discharge or release of liability shall be furnished to Surety by the obligee. c) Upon written demand, to deposit with the Surety a sum of money requested by Surety to cover any claim, suit, expense or judgment that Surety in its absolute discretion determines necessary and the deposit shall be pledged as collateral security on any bond or other bonds the Surety may have issued for the undersigned. 3. Surety and undersigned agree that the place of performance of this agreement, including the promise to pay Surety. 4. Surety is authorized to investigate, at any time, the undersigned's credit, employment history, and department of motor vehicle records. Privacy Notice: All nonpublic personal information gathered pursuant to the application shall not be disclosed except as permitted by law. 5. Surety, at its sole discretion and without notice to the undersigned is authorized, but not required, to make or consent to changes in the bond or to issue substitute bonds or renewals thereof and this indemnification shall apply to such change, substitute or renewal bond.