Agreement To Pay Premiums And Personal Guaranty Form printable pdf download

Agreement To Pay Premiums And Personal Guaranty Form

AGREEMENT TO PAY PREMIUMS AND REASONABLE ATTORNEY’S FEES

AND COSTS WHICH MAY BE INCURRED IN COLLECTION OF SUCH PREMIUMS

(To be completed by all applicants)

In order to induce the South Carolina Home Builders Self Insurers Fund of Columbia, South Carolina to accept

________________________________ as a member and an insured, the undersigned agrees to pay any and all

premiums due or which become due from the undersigned to the South Carolina Home Builders Self Insurers Fund of

Columbia, South Carolina, including reasonable attorney’s fees and all costs which might be incurred in the collection

of such premiums. The undersigned agrees that this agreement includes all past due balances, current balances, and

future balances hereafter incurred by the undersigned.

Executed this ________ day of ____________________________, ________________.

(month)

(year)

Applicant’s Name:____________________________________________(SEAL)

Resident Address:__________________________________________________

Resident Phone #:__________________________________________________

Signature:________________________________________________________

PERSONAL GUARANTY

(to be completed by applicants who are corporations, limited liability companies,

limited liability partnerships, or partnerships)

In order to induce the South Carolina Home Builders Self Insurers Fund of Columbia, South Carolina to accept

as a member and as an insured, I / we hereby, personally and individually guarantee the payment of

any premiums due or to become due by the company above listed to South Carolina Home Builders Self Insurers Fund,

including reasonable attorney’s fees which might be incurred in the collection of such premiums. This guaranty shall

include all past due balances, current balances, and future balances hereinafter incurred by

This guaranty shall remain in full force and effect until revoked in writing by the maker hereof in the same manner by

which this guaranty has been made.

Executed this

day of

(month)

(year)

Individually and as Guarantor(s): (Must include social security numbers and dates of birth for all guarantors.)

GUARANTOR(s):

Signature:_____________________________(SEAL)

Name:________________________________

Name:_________________________________

Resident Address:_______________________

Resident Address:________________________

Resident Phone #:_______________________

Resident Phone #:________________________

SSN:_______________ DOB:______________

SSN:_______________ DOB:_______________

Agreement To Pay Premiums And Personal Guaranty Form