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3688-42008 DUPLICATE COPY A000urd !trim Page 10 of 14 The form number is replaced with the following: 'CRLDI-DOC-CCSG 11/05' Car Rental Loss and Damage Insurance is underwritten by AMEX Assurance Company, Administrative Office, Green Bay, WI. Coverage is determined by the terms, conditions, and exclusions of

ees and grace periods by calling 1.800.518.8866. Change of Address I owed on kcal do not use street address Cory, State Bp Code Area code end Horne Phone Area Code and Work Phone Enka (option) To Pay By Phone 1-800472-9297 Customer Service and Lost or Stolen Card 1-877-877-0987 24 hoursa

the Rental Company. This coverage is in excess to your other sources of insurance and applies for the first 30 days of rental. Car Rental Loss and Damage Insurance is underwritten by AMEX Assurance Company, Administrative Office, Green Bay, WI. Coverage is determined by the terms, conditions, and exclusions of

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