| Document Date: 2013-09-23 12:28:50
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City Miami / / Company AMEX / Insure & Go Insurance Services USA Corp. / YES NO YES NO Company / Insure & Go USA / Page / / / IndustryTerm travel showing names / tour operator / unused and used travel tickets / i.e. travel insurance / Travel insurance / travel / airline / carrier etc / travel tickets / bank / home owners insurance / bank/credit card account / travel expenses / Date/time travel / outward and return travel / insurance / unused travel tickets / / Organization Corporate Center / Highways Agency / / / Position physician / treating physician / travel agent / tour operator/travel agent / / Product If / / ProgrammingLanguage FL / / ProvinceOrState Florida / / Technology cellular telephone / /
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Date: Insure and Go USA Claim Form 7300 Corporate Center Drive Suite 601 Miami, FL 33126