Figure: 7 TAC §90.203(b)(12)

"Credit insurance is optional.

Credit life insurance, credit disability insurance and involuntary unemployment insurance are not required to obtain credit. They will not be provided unless I sign and agree to pay the extra cost.

 Credit Life, one borrower $_________              Credit Life, both borrowers $_________         Term _____.

 Credit Disability, one borrower $________     Credit Disability, both borrowers $________  Term _____.

 Credit Involuntary Unemployment Insurance, one borrower $__________    Term _____.

 If this box is marked, the premium for the insurance coverage(s) above is not fixed or approved by the Texas Insurance Commissioner.

I want the insurance above.

Borrower’s Signature: ______________________     Date: _____

Co-Borrower’s signature: ___________________      Date: _____"