you are doing your own claim...
then you do not need to complete this form.
It is only needed if we are doing the claim
for you. This permits your insurance company
to pay us. When we receive payment from the
insurance company, we'll contact you so that
you can pay us the balance. We will not ship
any product until payment in full is
Amjo Corp - 513-942-2770
USA Toll Free 1-877-BUY-AMJO
The company with the sunny disposition UVGuy's Blog