AAA Membership Dues and Insurance Automatic Payments

Credit or Debit Cards Terms and Conditions

The Authorization Agreement at the bottom of this page is valid only for insurance policies written by the issuer of the policies identified below (“Insurer”) and for your membership with the AAA
club that issued the membership identified below (“AAA”).

Insurance: Automatic charges to your credit/debit card for insurance policies will begin with the first automatic payment billed after the Authorization Agreement is received and processed
(please allow 15 days for processing). Until then, your insurance payments are still due on the date shown on your billing statements and should be returned to AAA in the envelope provided.
Once automatic payment is active, your periodic billing statements will indicate the amount and timing of the next payment prior to your card being charged. At the time you applied for the
insurance policy(ies) and before renewal, you have been provided notice of the policy premium and the amount of all applicable fees. If changes are made to your policy, you will receive notice of
the revised policy premium. Installment payment plans and all fees are subject to change without notice. If you would like to enroll more than two insurance policies in automatic payments,
please use one Authorization Agreement for every two policies. Separate Authorization Agreements are required if using different credit or debit cards for each policy. Automatic payments are
subject to all applicable installment and other fees.

By providing your phone number, you agree that we may contact you via a prerecorded voice message, auto-dialer, or text message in the event of a payment failure with your insurance
payment and in other circumstances. If your card issuing institution participates in the Card Account Updater program, we may receive an updated card account number and/or expiration date for
your card on file. Unless you opt out of the program with your card issuer, we will update our files and use the new information when we bill you under your payment option. We will not receive
updated information if your account has been closed. Payments that cannot be processed or payments returned unpaid or otherwise rejected by your financial institution may result in cancellation
of automatic payments enrollment as to all your insurance policies with the Insurer. In the event that this occurs for your insurance payment, you will be notified and a return payment fee and/or
late fee may be added to your bill (or to a second attempted debit to your account). If insurance automatic payments are cancelled, installments remaining for the current insurance policy period
will be billed on your regular payment plan. If an error is made, you give the Insurer and AAA permission to correct it by initiating debits or credits to your credit/debit card file.

You may cancel automatic payments as to your insurance policies or update your credit or debit card account number and/or expiration date at any time by calling (800) 924-6141, going online at
AAA.com/myaccount or visiting your local branch. You may cancel your insurance policies at any time by calling (800) 924-6141 or visiting your local branch.

Membership: AAA Auto Pay - Annual Dues: If you select Annual Dues below, your AAA membership will automatically renew annually unless you contact us to cancel. We will send a statement
of your current services and renewal dues amount no less than 30 days prior to the expiration of your annual membership. Unless you contact us to make changes, cancel automatic payments or
cancel your membership, we will automatically renew your membership and charge the dues shown on your statement approximately 10 to 15 days prior to your expiration date from your
debit/credit card account on file. A AAA Auto Pay discount applies only to the membership of the member opting for AAA Auto Pay, is for promotional purposes, nonrefundable, nontransferable,
has no cash value, and is not valid after the membership cancels. Discount is only for members enrolling in AAA Auto Pay for the first time. Discount will be applied at the time of AAA Auto Pay
enrollment for new memberships or at membership renewal for existing members if enrolled in AAA Auto Pay at the time of renewal. Discount subject to offer terms and conditions.

Automatic Payments - Monthly Dues: If you select Monthly Dues below, this option for an annual AAA membership requires the authorization of automatic monthly dues payments charged to a
credit or debit card. Upon joining, when you make changes to your membership, and no less than 30 days prior to expiration of your annual membership, a notice will be sent to you including the
monthly dues payment amount and monthly payment dates. If the month ends before your scheduled payment date, your scheduled payment date for that month will be the last day of the
month. Your payment will be processed up to 4 days after your scheduled payment date. If you add or delete associate members or change member benefit options and the monthly dues
payment amount changes, your new dues payment amount will be effective within 2 monthly billing cycles. If the change results in a reduction of your monthly dues payment amount, both a
charge and refund may appear on your next card statement. New associates or benefit level upgrades will be effective immediately upon processing, subject to wait periods for roadside
assistance benefits. If you remove an associate, reduce your benefit level or cancel your membership, those changes must be made at least 3 days prior to your next scheduled payment date to
be effective at the end of the current payment month. Monthly dues payments are non-refundable. If we are unable to process your monthly payment, you will need to re-authorize monthly
automatic dues payments and make the past due payment at least 3 days prior to your next scheduled payment date or your membership will be cancelled. Discounts on membership dues and
promotional offers will not apply when enrolling in, during, or changing from the monthly dues option. New membership is required if you change to or from the monthly dues option. The
monthly dues option is not available in New York. Membership cancellation will be effective immediately prior to your next scheduled payment date. If you cancel automatic payments, your
membership will be cancelled and you will be billed for any roadside assistance services used after your missed payment.

Annual or Monthly Dues: By providing your phone number, you agree that we may contact you via a prerecorded voice message, auto-dialer, or text message in the event of a payment failure
with your membership dues and in other circumstances. If your card issuing institution participates in the Card Account Updater program, we may receive an updated card account number and/or
expiration date for your card on file. Unless you opt out of the program with your card issuer, we will update our files and use the new information when we bill you under your payment option.
We will not receive updated information if your account has been closed. Payments that cannot be processed or payments returned unpaid or otherwise rejected by your financial institution may
result in cancellation of automatic payments enrollment and membership. You may cancel automatic payments or update your credit or debit card account number and/or expiration date at any
time by calling (800) 924-6141, going online at AAA.com/myaccount or visiting your local branch. You may cancel your membership at any time by calling (800) 924-6141 or visiting your local
branch. Please refer to the AAA.com/MemberGuide for more details regarding your membership.

To have your insurance premiums or membership dues automatically charged to your credit or debit card each year or each month (as applicable),
complete and mail the form below using the envelope provided or return to:

AAA
P.O. Box 25499, Santa Ana, CA 92799-5499 OR Fax: 714.850.8097

Important: We must have a signature to complete this transaction. Please do not return by e-mail.

Keep a copy for your records.

ACH0801A.E20181010 PX3
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Please detach at line.
AUTHORIZATION AGREEMENT FOR INSURANCE AND MEMBERSHIP CREDIT OR DEBIT CARD PAYMENTS
AUTOMATIC PAYMENT OPTIONS
♦ To use automatic payments for your membership, enter your Club Code and Membership Number as it appears on your membership card in the boxes below.
♦ Please enter the number of each insurance policy you want on automatic payments.
♦ If the last 4 digits of your credit or debit card are not printed below, please enter your complete account number and card expiration date below.

Letter Prefix (up to 3) Please choose one:

POLICY # T H O - 1 4 9 3 3 4 1 8 3 Annual Dues Monthly Dues

Letter Prefix (up to 3) Club Code First 8 Digits of Membership Number
POLICY # MEMBER #
I hereby authorize the insurance company that issued the policies identified above ("Insurer") and AAA Texas, LLC ("AAA") to charge my CREDIT or DEBIT
CARD ACCOUNT indicated below for (i) all amounts that become due by me to the Insurer, including, without limitation, insurance premiums on the above
policies and any renewals and amendments thereof, finance charges, installment, returned payment, late payment and other fees, and (ii) all membership dues
that become due by me to AAA. All charges to my Credit or Debit account are governed by the Terms and Conditions that accompanied this Agreement.
Visa® MasterCard® EXPIRE
Discover® American Express®
CARD #
DATE 3784 11 / 2020
MM YY
This authorization is to remain in full force and effect until terminated by the Insurer or AAA, or until the Insurer or AAA has received notification from me of its
termination in such time and in such manner as to afford the Insurer or AAA, as applicable, a reasonable opportunity to act on it.
Electronically Signed 2020-02-01 16:10:08 UTC - 108.204.164.213

2020-02-01 10:16:48 (UTC-06:00)

DUNCAN, CLAUDETTE AssureSign® 297595f3-f456-4ce7-997c-ab53013088e9

NAME OF ACCOUNT HOLDER DATE SIGNATURE OF ACCOUNT HOLDER

E650415 707 252-40416376-06 Gilbert, Darlene
AAA Employee # (if applicable) Branch/Sec # Mebership # Member Name 8454 9/18
 AUTO CLUB INDEMNITY COMPANY
POLICY NUMBER
Property Insurance Application THO149334183

NAMED INSURED POLICY TYPE - HOD - HOMEOWNERS DELUXE POLICY

Darlene Gilbert and Claudette Duncan TERM BEGINS (BUT NOT PRIOR TO TIME APPLIED FOR)
5709 Guadalajara Dr
FROM 02/07/2020 12:01 AM TO 02/07/2021 12:01 AM
North Richland Hills, TX 76180
LOCATION OF RESIDENCE PREMISES (if different from above) YEAR BUILT
1987

NAME DATE OF BIRTH OCCUPATION

1. Darlene Gilbert 05/05/1945 Retired
2. Claudette Duncan 12/04/1943 Retired
3.
4.
COVERAGES AND LIMITS
Section I – Property Coverages Section II – Liability Coverages
A B Deductible Deductible Deductible C D
Dwelling/ Other Unscheduled Personal Clause 1 Clause 1 Clause 2 Personal Liability Medical Payments
Structures Property/ Off Premises Loss of Use Wind/Hail Named Storm Other Covered Perils (Each Occurrence) (Each Person)
$249,000 $149,400 $49,800 $2,490 $2,490 $100,000 $1,000
ENDORSEMENTS SELECTED
NUMBER TITLE LIMIT PREMIUM
HO101 Replacement Of Personal Property $149,400 $109

ADDITIONAL INFORMATION
1. Primary Residence? ............................................................................................................. Yes
2. Seasonally Occupied? .......................................................................................................... No
3. Occupied By? ....................................................................................................................... Owner
4. Own any dogs?..................................................................................................................... No If "YES," how many?.............................
5. Any property insurance losses and/or litigation in the past five (5) years? ............................ No If "YES," how many?.............................
PREMIUMS
Standard Premium Discount Amount Discounted Premium Increased Liability Premium
$2,394 $1,258 $1,249 $2
Increased Medical Premium Policy Premium Total Endorsement Premium TOTAL PREMIUM
$2 $1,249 $109 $1,358
BINDER OF INSURANCE
The Auto Club Indemnity Company hereby acknowledges itself bound for the coverages as are indicated by specific premium deposits on the application for
insurance, subject to all of the provisions of the Auto Club Indemnity Company’s applicable policy form. The issuance of a policy or a policy endorsement to the
named insured shall void this binder. A pro rata premium charge will be made unless such a policy is issued. This binder is not to be construed to afford
cumulative insurance with any existing policy. This binder shall expire sixty (60) days from the effective date shown on the application or may be cancelled by the
named insured at any time during such sixty-day period. The Auto Club Indemnity Company may cancel this binder by mailing to the named insured at the address
shown on the application written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. This binder is not valid unless
signed by an authorized representative.
I have read and accept all statements, notices, terms and agreements appearing on all pages of the Auto Club Indemnity Credit Number: E650415
Company property insurance application including any attachments which are part of the application. I declare that all
statements I made are true and are made for the purpose of obtaining insurance. To the extent my authorization is required Memo Number:
under applicable law, I authorize the Auto Club Indemnity Company, its agents, and the employees of each to verify the
accuracy of the information I have provided using any other available sources. Amount Collected: $1,358

Electronically Signed 2020-02-01 16:10:21 UTC - 108.204.164.213

THE AUTO CLUB INDEMNITY COMPANY HEREBY EXECUTES THIS BINDER
DUNCAN, CLAUDETTE
AssureSign® 0fa4c0ad-514c-4ab0-a15b-ab53013088f1
2020-02-01 at
10:16:48 (UTC-06:00) at
SIGNATURE OF APPLICANT DATE O'CLOCK AM/PM AUTHORIZED REPRESENTATIVE DATE O'CLOCK AM/PM

LTXH0200A Insurance provided to qualified AAA Texas members by the Auto Club Indemnity Company. 8152 11/18
E20150226 Pg. 1 of 1
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 AUTO CLUB
INDEMNITY COMPANY

Acknowledgement of Wind/Hail Deductible

Named Insured: Darlene Gilbert and Claudette Duncan Policy Number: THO149334183

¨ I understand that homeowners insurance policies covering roofs 15 years or older* are required to have a minimum
Wind/Hail deductible of 3% (of coverage A - Dwelling).

¨ I understand that the minimum Wind/Hail deductible of 3% (of coverage A - Dwelling) will be applied to my policy at
the subsequent renewal upon my roof age becoming 15 years old* if my current deductible is lower than 3% (of
coverage A - Dwelling).

¨ I understand that the minimum Wind/Hail deductible of 3% (of coverage A - Dwelling) can be lowered at my request
if I choose one of the following two options below:

Option 1: The minimum Wind/Hail deductible of 3% (of coverage A - Dwelling) can be lowered by providing acceptable
proof that my roof has been replaced by a professional roofing contractor within the past 15 years*.

Option 2: The minimum Wind/Hail deductible of 3% (of coverage A - Dwelling) can be lowered to a $1,000 deductible if I
add the Roof Surfaces Loss Settlement Endorsement (HO-150). With this endorsement roof losses caused by windstorm,
hurricane or hail resulting in total roof replacement will be settled at a percentage of the roof's replacement cost after my
$1,000 deductible is applied.

If your policy also includes a separate Named Storm deductible, a Named Storm deductible of 3% (of coverage A -
Dwelling) or higher will also apply at renewal upon your roof age becoming 15 years or older* due to the age of your roof.
(If you currently carry a Named Storm deductible higher than 3% (of coverage A - Dwelling), the higher deductible will
continue to apply).

*Minimum deductible requirements do not apply to roofs 15 years or older that are made of metal or slate.

By signing below, I acknowledge that I have read and understand the Wind/Hail Deductible as described in this
notice and that I received a copy of this notice for my records.

Electronically Signed 2020-02-01 16:16:13 UTC - 108.204.164.213

DUNCAN, CLAUDETTE
AssureSign® 6fc6409d-517a-461f-8125-ab5301308928
2020-02-01 10:16:48 (UTC-06:00)
Signature of Named Insured Date

LTXH0316A
E20180701 8764 7/18
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 AUTO CLUB INDEMNITY COMPANY

NOTICE TO APPLICANT
Homeowners Policies

THO149334183
Homeowners Policy Number

MULTI – POLICY DISCOUNT

A Multi-Policy Discount may be applied to your homeowners, condominium or tenants policy if at
least one named insured is also a named insured on an existing or new automobile policy.

The discount will be discontinued from your homeowners, condominium or tenants policy if the
automobile policy is cancelled or not renewed.

COMPANION AUTO INSURANCE POLICY REQUIRED

To qualify for a AAA Texas homeowners insurance policy (excluding condominium and tenant
policies), you must have a valid AAA Texas automobile insurance policy. In order to continue
your homeowners insurance policy with us at renewal, we will verify that you have an active AAA
Texas automobile insurance policy. If we cannot verify that you have a valid AAA Texas auto
insurance policy, your homeowners insurance policy may be non-renewed.

PREMIUM PAYMENT OPTIONS

Insureds may pay the annual premium in full or in installments.

Each installment billed (with the exception of the initial renewal installment) is subject to a $6.

The installment fee for policies set up on our automatic payment plan (AAA Auto Pay) is $1 if
payments are debited from a checking account or $4 if payments are debited to a credit or debit
card.

You must pay the outstanding balance in full in order to avoid paying any additional installment fees.

Each late payment is subject to a $10 fee and each returned payment is subject to a $25 fee.
Installment payment plans and charges are subject to change at any time. An adverse payment
record (such as a late payment, a nonpayment or a returned payment) may result in the
reduction in the number of remaining installments and an increase in the minimum amount
due, or a request to pay the entire balance of the policy bill in full.

Electronically Signed 2020-02-01 16:16:43 UTC - 108.204.164.213

DUNCAN, CLAUDETTE
AssureSign® abd058f8-b23e-4952-848d-ab5301308937

LTXH0110A 8172 02/19

E20181220
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