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Get and Sign AMERICAN VALET CLAIM INFORMATION

Get and Sign AMERICAN VALET CLAIM INFORMATION

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Insurance company. TYPE OF CLAIM Damage Theft Vehicle Yes Other No Full Name PLACE OF INCIDENT City State Phone Cell Phone Claim Check Driver s License Plate Color Year Make Parking Facility Address Time In Driven By Time Out Description and Comments Zip Model Date Was Damage Reported Before Customer Left Premises DAMAGE Other Specify E-mail VEHICLE Personal Injury Indicate Damaged Areas With an X Front of Vehicle Driver s Side THEFT INJURED PERSON Was Theft Reported to Police Item Stolen of...
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