R590-196-6. Disclosure Form

The bail bond surety and its agents will use the following disclosure form or a form that contains similar language.

TABLE

XYZ Bail Bonds Disclosure Form

1234 South 1234 East, Salt Lake City, UT 84444:

801-123-4567 fax: [phone]

Defendant.......................Co-Signer......................

Court...........................Charge.........................

Bond amount $...................Bond number....................

Initial Fees, non-refundable.

....bond premium, maximum: no more than 20%;

    minimum: not less than 10%; $......

....document preparation, not to exceed $20

    per set of bond forms. $......

....credit card fee, not to exceed 5% of amount

    charged to credit card $......

                                   total initial fees $......

Additional Fees.

     (1) Limited to actual and reasonable expenses required

because the defendant fails to appear before the court at any

designated times, or fails to comply with the court order, or

fails to comply with the terms of the bail bond agreement or

any promissory notes pertaining to that agreement. The following

are some reasonable expense fees:

     (i) reasonable expense fee for mileage is IRS mileage

reimbursement standard for business miles;

     (ii) reasonable apprehension expense fees include

meals at mid-range restaurants, lodging at mid-range hotels,

transportation at no more than coach fares; and

     (iii) reasonable collateral expense fees: actual

expenses to obtain collateral and, actual storage expenses,

if collateral is in a secured storage area.

     (2) A late payment fee of $20 or 5% of the

delinquent periodic payment whichever is less.

     (3) If a fee is charged by the court or the jail to

process a bail bond, the actual fee charged may be passed

through to the defendant or the co-signer.

Grounds for revocation of bond.

     Should the defendant violate any of the following, the

defendant shall be subject to immediate bond revocation andthe defendant, or the co-signer, or both, shall be subject to

all the costs incurred to return the defendant to the court.

Grounds for revocation include the following:

     (a) the defendant or co-signer providing materially false

information on bail bond application;

     (b) the court's increasing the amount of bail beyond sound

underwriting criteria employed by the bail bond agent or bail

bond surety;

     (c) a material and detrimental change in the collateral

posted by the defendant or one acting on defendant's behalf;

     (d) the defendant changes their address or telephone

number or employer without giving reasonable notice to the bail

bond agent or bail bond surety;

     (e) the defendant is arrested for another crime, other

than a minor traffic violation, while on bail;

     (f) the defendant is back in jail in any jurisdiction and

revocations can be served prior to the defendant being released;

     (g) failure by the defendant to appear in court at any

appointed times;

     (h) finding of guilt against the defendant by a court of

competent jurisdiction;

     (i) a request by the co-signer based on reasons (a)

through (h) above. Items (a) through (h) pertain to the

defendant; items (a), (c), (e) (g) and (i) pertain to

co-signers, if any.

Collateral.

     The following has been given as collateral to guarantee

all court appearances of the defendant until the bond is

exonerated:

...............................................................

...............................................................

...............................................................

     The following has been given as collateral to guarantee

payment of bond fees:

...............................................................

...............................................................

     In the event judgment is entered against the surety or the

bonding fee is not paid according to the terms of the bail bond

agreement and its promissory note, if any, following written

notice to the undersigned of such judgment or non-payment, the

undersigned authorize XYZ Bail Bonds to convert the appropriate

collateral to collect the judgment or the unpaid bond fees.

Should proceeds from the sale of the appropriate collateral be

insufficient to cover the outstanding balance due, the defendant,

the co-signer, or both, agree to be personally liable for the

difference. Should proceeds from the sale exceed the

outstanding balance, the difference will be returned to the

depositor of the collateral. The depositor's signature below

constitutes acknowledgment of a Bill of Sale for the

collateral. The depositor accepts this agreement as a bill of

sale for the collateral.

     By signing below I certify that I have read and understand

this disclosure form, the bail bond agreement and its

attached promissory note, if any. I certify under penalty of

perjury that all information given to XYZ Bail Bonds verbally

and in writing on all documents relevant to this bond are true

and accurate. The co-signer agrees that should the co-signer

request XYZ Bail Bonds to revoke the defendant's bond, with or

without probable cause, the co-signer will be responsible to

pay XYZ Bail Bonds and their agents for the time returning

the defendant to jail at the rates stated above in additional

fees. If requested by the co-signer to revoke the bond

without probable cause, the co-signer will be responsible to

reimburse the defendant his bond fees.

Date..............................Defendant....................

Date..............................Co-signer....................

Date..............................Depositor....................

I,......................................., agent of XYZ Bail

Bonds, certify that I have given a copy of all documents

pertaining to this bail bond agreement to the defendant, the

co-signer, the depositor, or any of the above, at the time and

date said bail bond agreement was executed.

Date....................Bail Bond Agent........................