AXEL BAIL BONDS

AUTHORIZATION TO CHARGE CREDIT CARD FOR THE PAYMENT OF
BOND PREMIUM OR RENEWAL THEREOF

 premium not to exceed the sum of $

 issuance of said bond(s) to the credit card account more fully described below.

The authorization information below will be held on file in confidence. The credit card may be checked for validity before issuance of the bond(s).  The card number below may be used to pay the premium when it becomes due until this authorization is cancelled in writing by the undersigned, provided, however, if the bond obligation undertaken by Axel Bail Bonds, Inc is non-cancelable, this authorization will remain in full force and effect until such time as the bond obligation referred to herein is fully exonerated and discharged.

Applicant agrees that Axel Bail Bonds, Inc may pursue all avenues of collection, including use of collection agencies, and authorizes the Surety to submit credit card charges using the charge card listed below to recover all payments due and all other unpaid amounts for payment of premiums.

I hereby declare that I am the holder of the above credit card, or have been authorized by the holder of said credit cards, to use it to pay premium(s) provided by Axel Bail Bonds, Inc. I also understand that this credit card may be charged for any future invoice renewal premiums that may become due and payable.