Credit Card Authorization
Fort Bend County

I, Indemnitor name field , the undersigned, request Derrick Dixon DBA ASAP Bail Bonds and/or Lexington National Insurance to charge $ Charge field USD to my credit/debit card.

These charges to my card are for the purpose of paying a bail bond fee and or pledging collateral for the benefit of benefit field .

I understand and agree if I am charging my credit/debit card for the purposes of pledging collateral, the percentage that the merchant is charged by the credit card company will be deducted from the amount that the bonding company is holding for collateral. I understand when the bail bond is terminated, the collateral will be returned 30 days from the termination date less the merchant’s percentage.

I understand my credit/debit card will be charged whatever fees incurred in the event the defendant fails to show up for court. Fees include but not limit to paying court costs, attorney fees, apprehension fees, etc.

Financial Institution: My card is (check one):

Bank information

I hear by authorize Derrick Dixon DBA ASAP Bail Bonds and or Lexington National Insurance to process a financial transaction to my credit/debit card and/or ACH Transaction. Should the defendant not report to court as agreed.

MM slash DD slash YYYY

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