|PREMIUM FINANCE AGREEMENT||Florida|
|P.O. Box 3066 - 3522 Thomasville Rd.|
|***A939343***||Tallahassee, FL 32315|
FOR VALUE RECEIVED, BORROWER PROMISES TO PAY to the order of Lender at the address given at the top of this page, the Total Amount Financed and all sums shown above, including interest at the Annual Interest Rate and other charges as described hereinafter, pursuant to the terms stated below and in page 2 of this Agreement.
1. SECURITY FOR PAYMENT: To secure payment of all sums due under this Agreement, Borrower grants Lender a security interest in any unearned premiums or other sums which may become payable under the Schedule Policies of Insurance shown on page 3
2. LIMITED POWER OF ATTORNEY: BORROWER IRREVOCABLY APPOINTS LENDER AS ATTORNEY-IN-FACT TO CANCEL THE SCHEDULED POLICIES OF INSURANCE AFTER BORROWER DEFAULTS IN MAKING PAYMENTS UNDER THIS AGREEMENT.
3. NOTICE TO BORROWER: (1) Do not sign this Agreement before you read it, or if it contains any blank space, (2) You are entitled to a completely filled in copy of this Agreement, (3) Under the law, you have the right to pay off in advance the full amount due and under certain conditions to obtain a partial refund of the service charge, and (4) BY SIGNING BELOW BORROWER AGREES TO THE PROVISIONS ABOVE AND ALL OF THE TERMS WHICH APPEAR ON THE SECOND PAGE OF THIS AGREEMENT AND ACKNOWLEDGES RECEIPT OF COPIES OF PAGES 1, 2 AND 3 OF THIS AGREEMENT
SIGNATURE OF ALL INSURED[S] NAMED IN THE POLICIES OR AUTHORIZED AGENT OF INSURED[S], AS PERMITTED BY LAW:
|Name and Title:||Date||Name and Title|
PRODUCERS REPRESENTATIONS & WARRANTIES:
The undersigned Producer represents and warrants that: (A) The cash Down payment shown above has been paid by or on behalf of the Borrower. (B) The Total Price of premiums shown above has been or will be used to purchase insurance policies shown in the scheduled policies of insurance on the page 3 of the Agreement Any portion of the Total Price of Premiums received by Producer that is not used to purchase such insurance policies, as well as any refunds or credits on such policies, shall be promptly paid to Lender (C) To the best of the undersigneds knowledge and belief, Borrower is not subject to any bankruptcy or insolvency proceedings and Producer has no reason to believe that Borrower is insolvent (D) The Borrowers signature(s) is (are) genuine and authorized, or to the extent permitted by applicable law, the Producer has been authorized by Borrower to sign this Agreement on Borrowers behalf (E) Producer has delivered or will deliver a copy of this Agreement to Borrower. Producer agrees that the Representations & Warranties above, as well as those on page 3 of this Agreement, are a binding contract between Producer and Lender.
PRODUCER / AGENCY