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tion Date Rental: MIAMI FL 06/10/06 Return: W. PALM BCH FL 08/1W06 Agreement Num Renter Name:

uated and that We may make a determination as to whether the claim may be paid. Except in the instance of theft or Destroyed Ticket, as noted under the Description of Benefits, We will require that You provide Us with the Ticket which could not be used because of a Covered Incident for which insurance is provided under thi

ness lunches, pre-theater, or private events. 57 W. 48th St 212-262-6200. www.ajmaxwells.com. If the

t We may make a determination as to whether the claim may be paid. Except in the instance of theft, Destroyed Ticket or Lost Ticket, as noted under the Description of Benefits, We will require that You provide Us with the Ticket which could not be used because of a Covered Incident for which insurance is provided under thi

Customer Service. • Please print clearly In blue or black Ink only In the boxes provided. You mayvisit the American Express PdvacyStatement at VW/W. americanexpresszonSivacy for more details andtoset your email preferences. Large Print and Braille Statements 1-800-525-3355 Travel Emergency and

t We may make a determination as to whether the claim may be paid. Except in the Instance of theft, Destroyed Ticket or Lost Ticket, as noted under the Description of Benefits, We will require that You provide Us with the Ticket which could not be used because of a Covered Incident for which insurance is provided under thi

ness lunches, pre-theater, or private events. 57 W. 48th St. 212-262-6200. www.ajmaxwells.com. If th

t We may make a determination as to whether the claim may be paid. Except in the Instance of theft, Destroyed Ticket or Lost Ticket, as noted under the Description of Benefits, We will require that You provide Us with the Ticket which could not be used because of a Covered Incident for which insurance is provided under thi