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Binder for State Farm Automobile Insurance Page 3 <br /> QUACH, AUSTIN 2020 FORD TRANSIT 350 MEDIUM ROOF <br /> Notice of insurance information collection practices — personal, family or household insurance transactions: We may <br /> collect personal information from persons other than the individual or individuals applying for coverage. Such personal <br /> information as well as other personal or privileged information subsequently collected may, in certain circumstances, be <br /> disclosed to third parties without your authorization as permitted by law. If you would like additional information <br /> about the collection and disclosure of personal information, please contact your State Farm agent. You may also act upon <br /> your right to see and correct any personal information in your State Farm files by writing your State Farm agent to <br /> request this access. <br /> By submission of this application, you agree that: (1) you have read this application, (2) your statements on this <br /> application are correct, (3) statements made on any other applications on this date for automobile insurance with <br /> this company are correct and are made part of this application, (4) you are the sole owner of the described vehicle <br /> except as otherwise stated, and (5) the limits and coverages were selected by you. IT IS FURTHER UNDERSTOOD AND AGREED <br /> THAT NO INSURANCE IS EFFECTIVE UNDER THIS AGREEMENT (A) UNLESS THE BINDER IS COMPLETED DESIGNATING THE COMPANY <br /> ACCEPTING THIS APPLICATION OR (B) UNTIL THE DATE THE POLICY OR BINDER IS ISSUED BY THE COMPANY ACCEPTING THIS <br /> APPLICATION. <br /> Consumer reports may be ordered in conjunction with this application. These reports provide information that assists <br /> with determining your eligibility for insurance and the price you are charged. <br /> ECHO App # 75 —2D5F—P31 App date and time: 11/22/2023 03 : 10 PM <br /> BINDERCA <br />