EFTA01705023.pdf

DUPLICATE COPY PreparolFor Account Muster Clain° Oolo Page 3 of 8 JEFFREY E EPSTEIN XXXX•XXXXX4-31005 01/29/07 Due in Full continued Amount S 01/14/07 AMAZON.COM AMZN.COM/BILL WA 39.40 98101 AMAZON.COM MERCHANDISE ROC No. 0052764279 01/14/07 AMAZON.COM AMZN.COWBILL WA 12.90 98101 AMAZON.COM MERCHANDISE ROC No. 0052777363 01/15/07 LIFE SCIENCE PHARMACHARRIMAN NY 46.00 PHARMACUETICALS Total Due in Full Activity 533.65 Important Notice Information on Flexible Payment Features Please refer to page 2 for further important You may have access to one or more Flexible Payment Features as pan of your Card account. The current Annual information regarding Percentage Rates (APRs) and Daily Periodic Rates (DPRs) for the Flexible Payment Features are as follows: your account For Sign & Travel, the APR is 14.15%, the DPR is 0.0388% EFTA01705023  DUPLICATE COPY Pnpond Fa Mca Page 4 of 8 JEFFREY E EPSTEIN )0000-)0000(431005 EFTA01705024  membeiatfitZfarlis Plus° Page 5 of 8 Monthly Statement and Program News American Exprets• For questions about your --Statement Period Membership Rewards account, contact December 1, 2006 • December 31, 2006 1-800-AXP-EARN Account activity after this period does not appear on this statement (297-3276) Praised for vanv.americanexpress.corn/rewards JEFFREY E EPSTEIN Available Points hkentarstip Rowan:b. Aecount Mote American Express 1M33334712 3,779,950 Membership Rewards P.O. Box 297813 Points are available when charges are paid in full and all your accounts are in Ft. Lauderdale, FL 33329-9785 good standing. Account Summary Opening points balance 3,608,588 New points earned +171,362 Points transferred or redeemed 0 Reinstated points and adjustments 0 New points balance =3,779,950 New Points Earned Forfeited Points 12/01/06 - 12/31/06 Points Activity On Bonus Points Due To Total Points Activity Eligible Charges Awarded Late Payment. Per Card Centurion 1,989 0 0 1,989 )000000=4-31005 Platinum 0 0 0 0 XXXX0000(X9-32002 Gold 17,022 0 0 17,022 XXxX->000303-42006 Adel Gold 52 0 0 52 >C00C-)000008-45019 Addl Gold 12,251 0 0 12,261 XXXX-XXXXXB-43030 Gold 0 0 0 0 XXXMOCODC2-61005 Add1Gold 92,149 0 -31,030 61,119 )00000000(2-63019 12/2006 • MCI Gold 73,448 0 -17,737 55,711 )000(40=1, -63027 12/2006 Add? Gold 25,360 0 -6,049 19,311 >C0000000262060 12/2006 Addl Gold 46,790 0 42,883 3,907 )0000000M-63076 12/2006 Totals 269,061 0 -97,699 171,362 Membership Rewards Plus points earned may be transferred or redeemed as long as all enrolled Card accounts are in good starving. Points transferred or redeemed cannot be reversed back into the program. Forfeited points can be reinstated for a fee by calling the number provided below. Eligible Card charges are outlined in the Membership Rewards Plus program Terms and Conditions in your Membership Rewards Plus Guide. If you have questions, please visit www.amedcanexpress.com/membershlprewardsplus or call 1.800-AXP-1090 (297-1090). From overseas, call collect 305-816-2799. Redeem Membership Rewards® Points for a Williams-Sonoma Gift Card With a gift card from Williams-Sonoma®, Cardmembers For a store near you, visit enrolled in the Membership Rewards program can outfit their williams-sonoma.com or call 1.800.541-2233. WILLIAMS-SONOMA kitchens with professional-quality cookware, cooks' tools, cutlery, and more. Williams-Sonoma offers the products and (MR Message 6118) expert advice that make cooking and entertaining at home a pleasure. Continued on reverse Offers are made only to Cardmembers who meet certain qualifying criteria. By responding you will be disclosing to the merchant that you meet these criteria. EFTA01705025  American Express• Preimadbr EliihIMATE COPY JEFFREY E Merntembp Reward:0 Amount Nuts Page 6 of 8 1 M33334712 Spoil Your Valentine and Earn 1Ox Points PLUS 100 Additional Bonus Points at FTD.com® Spoil your Valentine and earn 10x Membership Rewards® Spoil your valentine this points all year PLUS, through 2/15/07, earn 100 additional year with flowers and chocolates and earn 10x bonus points when you shop at ftd.com/amexpromo and points PLUS 100 pay with your American Express® Card. Choose from great additional bonus points Valentine's Day flower collections, gourmet gifts, plush teddy when you shop at bears, spa products, and more! ttd.com/amexpromo through 2/15/07. 10x pant oNer va1d though 12.61A77. 100 bonus pan Ober veld 121/06-2•15,07 Gay. Not veld h regal Mom a b conjuroton voth any cater VW Iran FTD. TO earn bans Petoe. ru Matto WOW In PO then-bets* Rewards program el eke line aFeegnese end charge we' Peen..." en eel/ (MR Message 7383) kneitan Expeees.Card. Boom pants wet. crodad to yaur Itcontorchp RONtaS =cull tee'10-12 ennennj weed a et ceder is dengeged aM charges diPaal On par Wog slatermot Bonus ID: 31175.4984. Redeem for Tumi Generation 4 Napa Leather Travel Kit in Black • 14,500 Points Enjoy the luxury of rich, full-grain leather in this popular slim To redeem, visit design. Refined, modern design, easy-access U-shaped membershiprewards. com/TumiTravelKit or call opening, handle, exterior pocket, water-resistant lining, 1.800-AXP-EARN interior elastic loops. Fits all your travel needs. Redeem for (297-3276) by February this or other great travel products only from American 15, 2007. Express.com. (Reward Code: CMP837, Points: 14,500). (MR Message 6421) Tema and condrions ot ere likerbenap Rowardo yogi= apply. Earn Double Points on Orders of $50 or More at KODAK Creative Network • All Year Long! Help grow your business with easy-to-create marketing To learn more about materials backed by Kodak's dependable customer service KODAK Creative Network, visit creative.kodak.com and earn double Membership Rewards® points on orders of and earn double points $50 or more from KODAK Creative Network when you pay today! with your American Express® Card until December 31, 2007. Rely on Kodak's customer service to deliver the exceptional (MR Bonus ID 0341) quality you demand. Offer veld IA/07-12151/07. To be ebbe so can bonus mints yea mud be erected ik the Atembersap Reward: program ("Preoptot) dam trne d paeane ad you mat charm. yea Pookamo1150 ta mae co an &gilt ended Moran Emcees Card. Born, melts we be MOMS to woo Program eccount 6.8 weeks eachavestypnr mats blirg etatemen1 Bonus ID: OWL Redeem Membership Rewards® Points to Plan a Winter Wonderland Vacation! Enter the world of Vail, Beaver Creek, Breckenridge, To preview this reward Keystone and Heavenly resorts, where you'll ski through and to redeem points, VAIL RESORTS' visit membership pristine alpine bowls, stroll in quaint villages lined with rewards.com or call Just amulet Pay Is Paradise' eclectic boutiques, take in the view of Heavenly's sparkling 1.800-AXP-EARN *OD * blue lake or carve turns on an immaculately groomed (297-3276). cruiser. This Spring enjoy warm weather skiing and signature (MR Message 8189) events like Spring Back to Vail and Breckenridge's Spring Massive. Create a unique vacation when you redeem Membership Rewards points for the ultimate ski experience. Turns ardecalboos ants Mentershb Rends program fogy.Fa mae agOMUM3A vise membershIpreward team. Get a Ticket Across the Pond on Virgin Atlantic Airways Enroll in Virgin Atlantic's award-winning loyalty program, To preview this reward and Flying Club, and exchange Membership Reward® points for to redeem points, visit membership miles, where upgrades await. Virgin Atlantic offers the best rewards.com or call virgin cabins in the sky, Premium Economy boasts a larger seat 1.800-AXP-EARN and Priority Boarding and Upper Class hosts an onboard (297-3276). atlantic bar, massages and a handsome amenity kit, for starters. (MR Message 2166) Purchase a full-fare ticket in Economy (Y or B class) or Premium Economy (W or S class) and upgrade today. Terns aM cordons ol Me Membershp Rewards program apply, O gnae integmagaweg membershiprewardtcont. En:We:bat ar carnet restootcns may fury. Tatie and fees may apply. Offers are made only to Cardmembers who meet certain qualifying criteria. By responding you will be disclosing to the merchant that you meet these criteria. EFTA01705026  DUPLICATE COPY Ptcpxod For Mean Nutter Ckeirg Wk. Page 7 of 8 JEFFREY E EPSTEIN )000(-XXXXX4-31005 01/29/07 CustomExtras- Trader Joe's Now Accepting American Express® Cards (CE 108463) Trader Joe's - A neighborhood grocery store where value and culinary adventure await, now accepts American Express Cards. Trader Joe's buyers travel the world in search of intriguing items and sure-fire staples. All items must pass through an opinionated and TRADER JOE'S' impassioned tasting panel when assessed for consideration in a Trader Joe's. The result is an appetizing array of high-quality groceries that tempt the palate, but won't break the bank. From bruschette to bananas. Stir fry to steak. Cashews to coffee. Come join the grocery shopping adventure at Trader Joe's. Now you can use your American Express Card at your neighborhood Trader Joe's. Now Accepting American Express® Cards! If there am other places where you would like to University of MD University College (UMUC) - Providing higher see the Card accepted, education to 90,000 working adults, military personnel, and students please call the Customer worldwide. umuc.edu or call 1-800-888-UMUC. Service number that is located at the top of your statement or the number Frederick's Downtown - Chic south-of-France bistro with refined that is on the back of your cuisine and a great bar scene. 637 Hudson St. at Horatio St., West Card. Village. Call 212-488.4200 or visit frederlcksnyc.com. (CE 108326) Athens Live - Mediterranean food, live music, beautiful atmosphere. Catering and parties available. Open Mon., Wed.- Sun. 33-12 36th Ave., Long Island City, NY. 718-729-4945. Enjoy Centurion Dining Reservations Around the World To make a reservation through Centurion Dini For dinner reservations across town, across the country, or across Reservations, please call the ocean, look to the Centurion Dining Reservations program 1.877.877.0987, option 2. available to you as a Centurion member. Every day, a reservation is held at more than 1,000 of the most highly acclaimed restaurants (CE 108399) ,CAR0 MEMBER BENEFITS . worldwide. So when the need arises for a reservation at a hometown favorite or an outstanding restaurant in another city, Centurion Dining Reservations can help. Reservations are provided on a first-come, first-served basis, so please call as early as possible. All cancellations must be made by calling Centurion Concierge at least 24 hours in advance of the reservation, otherwise a $15-per-person cancellation fee ($60 minimum; $120 maximum) will apply. Enjoy a Customized Voyage Aboard Your Own Private Yacht For more Information about the broad range of The new Private Yacht Program offers a choice of distinctive yachts private yachts available for available for charter around the world, complete with professional charter, call the specialists crews and talented chefs. Chart your own course with custom at Centurion Travel itineraries, personalized menus and flexible, freestyle schedules. Service at 1.877-877-0987, option 1. Experience an exclusive private yacht charter vacation with a partner and receive a special benefit of $750 or more. (CE 108400) Program terms and conditions apply. For full program information, visit americanexpress.corrifeenturion. Pay Your Quarterly Taxes with Your Card and Earn Rewards americanexpress.corn/ taxes. Earn rewards while paying your taxes. You can pay your Quarterly (CE 108403) Estimated (1040ES) federal, state, and local property taxes as well as dAR0MEI14/4ER Quarterly Employee Withholdings (Form 941) business taxes with BENEFITS your American Express® Card. For additional information, visit americanexpress.com/taxes. All federal, state, local and business tax payments made with your Card are subject to a convenience fee charged by either of the two IRS-approved payment processors, Official Payments Corp. and PAY1040.com. All Card terms and conditions apply. Offers are made only to Cardmembers who meet certain qualifying criteria. By responding you will be disclosing to the merchant that you meet these criteria. EFTA01705027  DUPLICATE COPY JEFFREY E EPSTEIN XXXX-XXXXX4-31005 Page 8 of 8 Great Ski Resort Offers at My Ski Vacation Visit myllfemycard.comfsld for great ski resort offers. Visit My Ski Vacation at mylifemycard.comiski for great ski resort ist.CANNIEMBEll offers exclusively for American Express® Cardmembers. (CE 108427) BENEFITS .. . Whether you want to ski the moguls in Vermont or cruise the powder in Colorado, we have valuable offers to help you travel to your favorite resorts for an incredible ski vacation. Make Your Luxury Hotel Stay More Rewarding For more information and to see participating Whether you're seeking world-class skiing, championship golf, a properties, go to beach escape, or exclusive spa, the Destination Hotels & Resorts destInatIonhotels.com/ collection has a selection of over 30 resorts and hotels nationwide. rewards. Participating Destination Hotels & Resorts are offering American (CE 108429) Express® Cardmembers double Membership Rewards® bonus points through 12/31/07 when you pay with your American Express Card. Offer valid 111107-12/31/07. Maximum 2,500 bonus points on any single transaction. For eligibility, you must be enrolled in the Membership Rewards ("Program, at the time of stay and charge your stay on an eligible, enrolled American Express Card. Bonus points will be credited to your Program account 6-8 weeks after charges appear on your billing statement. Individual terms and concitions, as well as annual Program lees, apply for certain Card products. Bonus ID: 7313. Reward Yourself with USA TODAY! To redeem call 1.800.872.0001 and mention code 217 Start your day off right with home or office delivery of USA TODAY. or visit us at USA TODAY delivers the news you need to know, when you need it, usatodaysubscribe.comi USA in a concise format to save you time. Enrich your life with exclusive stories only found in USA TODAY. Just 13 weeks for $45.50, usat. TODAY 26 weeks for $81.00 or 52 weeks for $146.00. (CE 108410) Only American Express* Cards are accepted. Void in Alaska. Local sales tax when applicable will be added to your order. Sail Regent Seven Seas Cruises® with the Mariner Club Call American Express Travel toll free at With the American Expresso Mariner Club, the ocean is your playground. By 1-877-AXP-4666 and booking a Regent Seven Seas Cruises Sailing with the American Express Mention Promo Code: Mariner Club, you can enjoy competitive fares, a friendly and professional F2300001 to learn about onboard host, an exclusive cocktail party, a complimentary shoreside event, this and other exciting MARINER~ Repent Seven Seas LUB Cardmember-only benefits, and more! Visit Alaska and marvel at the beauty of its Mises. varied wildlife, massive glaciers, dense forests, and spring streams that somersault over 1,000-foot precipices. Depart on May 12th from San Francisco (CE 108402) for an 11-night visit that Includes Seattle, Skagway and Juneau. End your cruise in beautiful Vancouver, British Columbia. As part of the Mariner Club enjoy a morning tour of the gold rush town of Skagway and Jewell Gardens followed by lunch at a historic inn. Your home while on vacation will be Seven Seas Mariner, the world's first all-suite_, all-balcony ship, as well as the first to offer dining by the famed Le Cordon Bleuw of Paris. Discover the pleasure of sailing with Regent Seven Seas Cruises and the American Express Mariner Club. Mariner host, shoreside events and cocktail parties contingent on minimum number of passengers and are subject to change. Offers are capacity controlled and may be modified or withdrawn without prior notice. American Express Travel Related Services Company, Inc. acts solely as sales agent for travel suppliers and is not liable for the actionsAnactions of such suppliers. CST# 1022318-10, TA-002 Registered Iowa Travel Agency NV# 2001.0126, Washington UBI# 600.469394, ML# 1192. 2006 American Express. Ship's Registry: Bahamas Promo Code: F2300001. Offers are made only to Cardmembers who meet certain qualifying criteria. By responding you will be disclosing to the merchant that you meet these criteria. EFTA01705028  DUPLICATE COPY Centurion® Card :••.:P.]Membership Points Available "" Statement of Account 'aieSilitO7, when ehaijoi"due are paid full alb accountsfare,in good standi4 Ptcpuns Fa Clonm Deo JEFFREY E EPSTEIN 02/28/07 Page 1 of 8 New Activity S New Please Pay By Novi= Bata, $ Poignant netiAv Acinntnents Balance $ 03/15/07 533.65 -533.65 +1,547.18 1,547.16 Please refer to page 3 for important information regarding your account For assistance or questions about your account, contact us at www.americanexpress.com or call Customer Service at 1-877-877-0987. CioFhstaasswithUSAUnmays If you're traveling domestically or to Europe, make your flight with US Airways more comfortable with GoUpgrades. GoUpgrades are available beginning 30 hours prior to departure starting from as low as $50. GoUpgrades are available the day of departure at the ticket counter in the airport. Upgrade your flight today at the airport, by calling Centurion Travel Services at 1-877-877-0987 option 1, or visit usairways.com/goupgrades today! Upgrades are sold based on availability. Upgrades are available for purchase on flights for which a customer holds a confirmed, paid ticket. For more information and complete terms and conditions, visit usairways.com/goupgrades. Activity M 'Iga" argda" Amount S ?•02/12/e7,11pPayrnent Becerred.,!.,ThankYou. 7 %.7533.55; Amount Due in Full Activity for JEFFREY E EPSTEIN coicouccoxamawz 02/01/07 AMAZON.COM AMZN.COWBILL WA 277.84 98101 AMAZON.COM MERCHANDISE ROC No. 0063082962 02/14/07 AMAZON.COM AMZN.COM/BILL WA 41.93 98101 AMAZON.COM MERCHANDISE ROC No. 0071666635 4 Plowo isan at the pottcoatton new,detach old onion o41) your peomenl Continued on Page 3 Payment Coupon PocounMuMW Please Pay By: Please enter account 371546781431005 03/15/07 number on all checks and correspondence. Make check payable to American Express. JEFFREY E EPSTEIN See Finance Charges 457 MADISON AVE 4FL Total Amount Due section on reverse side for NEW YORK NY 10022-6843 $1,547.18 a description of when additional Finance Charges are not assessed on Features. 1,,,IIII,,,11$$$$$ Check here it address or telephone number has changed. Please note Mail Payment to: changes on reverse side. AMERICAN EXPRESS P.O. BOX 2855 NEW YORK NY 10116-2855 II II I I 11111111 II I III I I I I II I I I I II II I I II III I 0000371565781431005 000154718000154718 25 ri EFTA01705029  DUPLICATE COPY RowedFur Page 2 of 8 JEFFREY E EPSTEIN )0000CXXM4-31005 Payments: Payments received after 12:00 noon may not be credited until the next day. Payments must be sent to the payment address shown on your statement and must include the remittance coupon from your statement. Payments must be made with a single check or draft drawn on a US bank and payable in US dollars, or with a negotiable instrument payable in US dollars and clearable through the US banking system, or through an electronic payment method payable in US dollars and clearable through the US banking system. Your Account number must be included on all payments. If To Pay By Phone payment does not conform to these requirements, crediting may be delayed and additional Charges may be imposed. If we 1.800472.9297 accept payment made in a foreign currency, we will choose a conversion rate that is acceptable to us to convert your payment into US dollars, unless a particular rate is required by law. Please do not send post-dated checks. They will be Customer Service and deposited upon receipt. Our acceptance of any payment marked with a restrictive legend will not operate as an accord and satisfaction without our express prior written approval. Authorization for Electronic Debit: We will process checks Lost or Stolen Card electronically, at first presentment and any re-presentments, by transmitting the amount of the check, routing number, 1-877-877-0987 account number and check serial number to your financial institution, unless the check is not processed° electronically or a 24 hours/7 days less costly process is available. By submitting a check for payment, you authorize us to initiate an electronic debit from your bank or asset account. When we process your check electronically, your payment may be debited to your bank or asset Express Cash account as soon as the same day we receive your check, and you will not receive that cancelled check with your bank or 1.800-CASH-NOW asset account statement. If we cannot collect the funds electronically we may issue a draft against your bank or asset account for the amount of the check. Authorization for Electronic Payments: By using Pay By Computer, Pay By Phone International Collect or any other electronic payment service of ours you will be authorizing us to initiate an electronic debit to the financial account you specify in the amount you request. Payments received after 5:00 p.m. MST may not be credited until the next 1.954-503.8905 day. Allocation of Payments and Credits: Subject to applicable law, we wilt apply and allocate payments and credits among Features and Charges on your Account in any order and manner determined by us in our sole discretion. Finance Hearing Impaired Charges: Average Daily Balance (ADB) Method for Calculation of Finance Charges (FC): We use the ADB (9am-5pm EST) Method to calculate FC on your Account. Under this method, we figure the FC on your Account by applying the Daily TTY: 1.800.221-9950 Periodic Rate (DPR) to the ADB (as described below) for each Feature (including current transactions). Diftrent daily FAX: 1-800-695-9090 periodic rates may be applied to separate Feature balances. To get the ADB for each feature, we (1) take the beginning In NY: 1-800-522-1897 balance for each day (including unpaid FC from previous billing periods) (2) add any new transactions, debits, or fees, (3) subtract any payments °recedes, and (4 make any appropriate adjustments. For each day after the first day of the billing Large Print and Braille period, we also add an amount of interest equal to the preWous day's daily balance multiplied by the DPR for the Feature. This gives us the daily balance for the Feature for that day and the beginning balance for that Feature for the next Statements day. If this balance is negative, it is considered to be zero. Then, we add pp all the daily balances for the Feature for the 1.877.877.0987 • billing period and divide the total by the number of days in the billing period. This gives us the ADB for the Feature. If you pay the New Balance on this statement by the next Closing Date, then you will avoid additional FC on features includedin this New Balance. If you multiply the ADB for each Feature by the number of days in the billing period and the DPR for that Feature, the result will be the FC assessed on that Feature, except for variations caused by rounding. The total FC forte bilfingperiod is calculated by adding the FC assessed on all Features of the Account. This method of calculating the ADB and FC results in daily compounding of FC. Transactions Made in Foreign Currencies: If you incur a Charge in a The Centurion° Card foreign currency,it will be converted into US dollars on the date it is processed by us or our agents. Unless a particular rate is from American Express required by apace law, we will choose a conversion rate that is acceptable to us for that date. Currently, the conversion Customer Service rate we use for a Charge in a foreign currency is no greater than (a) the highest official conversion rate published by a P.O. Box 297846 government agency, or (b) the highest interbank conversion rate Identified btus from customary banking sources, on the Ft. Lauderdale, FL conversion date or the poor business day, in each instance increased by 2%. This conversion rate may differ from rates 33329-7846 in effect on the date of your charge. Charges converted by establishments (such as airlines) will be billed at the rates such establishments use. Billing Rights Summary: In Case of Errors or Questions About Your Bill: If you think your bill is Express Cash incorrect, or if you need more information about atransaction on your bill, write us on a separate sheet of paper at the Customer Service address noted to the right. We must hear from you no later than 60 days after we sent you the first bill on P.O. Box 297815 which the error or problem appeared. You can telephone us at the number indicated on the front of this statement, but doing Ft. Lauderdale, FL so will not preserve your rights. In your letter, give us the following information: 1. Your name and account number 2. The 33329-7815 dollar amount of the suspected error; 3. Describe why you believe there is an error. If you need more information, describe Payments the item you are unsure about. You do not have to pay any amount in question while we are investigating, but you are still obligated to pay the parts of your bill that are not in question. While we investigate your question, we cannot report you as P.O. BOX 2855 delinquent or take any action to collect the amount you question. If you have authorized us to pay your bill automatically from NEW YORK NY your checking or savings account, you can stop the payment on any amount you think is wrong. To stop the payment your 10116-2855 letter must reach us three business days before the automatic payment is scheduled to occur. Special Rule for Credit • Card Purchases: If you have a Problem with the quality of goods or services that you purchased with a credt card, and you have tried in good faith to correct the problem with the merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than $50 and the purchase was made in your home state or within 100 miles of your mailing address. (If we own or operate the merchant, or if we mailed you the advertisement for the property or services, all purchases are covered regardless of amount or location of the purchase.) Credit Balance: If a credit balance (designated CR) is shown on this statement, it represents money owed to you. If you do not make sufficient charges against the credit balance or request a refund, we will, within 30 days after expiration of the six-month period following the date of the first statement indicating the credit balance, issue a check to you for the credit balance if the amount is $1.00 or more. New York residents may contact the New York Banking Department to obtain acomparative listing of credit card rates, fees and grace periods by calling 1400-518-8866. Change of Address • To change your address online, visit wwwamericanexpress.com/updatecontactinfo r Correct on tioal • For Name or Company Name changes, please call the Customer Service do nzl VSO number on the back of your Card. • If your address or phone number has changed to a FOREIGN ADDRESS OR PHONE, please call Customer Service. • Please print clearly in blue or black ink only in the boxes pr