BROTHERS AND SISTERS IN STATE OR OUT OF STATE   Name:   Phone :   Address:   Name:   Phone :   Address:   Name:   Phone :   Address:   Name:   Phone :   Address:   BROTHERS AND SISTERS IN STATE OR OUT OF STATE   Name:   Phone :   Address:   Name:   Phone :   Address:   Name:   Phone :   Address:   PERSONAL REFERENCES (CLOSE FREIEND, BOSSES, CO WORKER, TEAMMATES etc)   Name:   Phone :   Address:   Name:   Phone :   Address:   Name:   Phone :   Address:   FINANCIAL INFORMATION   Credit card Name:   Card #   Exp   Credit card Name:   Card #   Exp   Credit card Name:   Card #   Exp   Name of the Bank:   Address of the Branch :   Savings Account #   Checking Account #   CreditUnion   Account #   Stocks or Mutual funds   Account #   LIST ALL AUTOMOBILES   1. Year   Make   Model   Color   Lic 2. Year   Make   Model   Color   Lic   LIEN HOLDER   INS.CO.   PHONE#   LIEN HOLDER   INS.CO.   PHONE# The Client hereby warrants that the foregoing declarations made and answers given are the truth without any reservation and are made for the purpose of inducing the surety to become surety or to procure surityship on the bond or undertaking applied for herein, with the intent and purpose that they be relied on fully. The client herby authorizes and directs his relatives, employers, bankers, the Federal Social Security Administration, the Internal Revenue the state depatment of Disability Insurance, the United States Armed Forces, the state Divisionof motar vehicles, all Municipal, Country, State and Federal Law Enforcement Agencies and any other persons or organizations having information concerning the client's whereabouts to give such information to Tina Lyles Co. and itz assigns and/or duly authorized representatives. The client hereby waives his or her rights with respect to the privacy act and authorizes the use of copies of this document by Tina Lyles Co. and its assigns and/or duly authorized representatives.   Client Sign Here       Mailing Address       Agent Witness       Signed and Deliver this   Card #   Exp