Claim Form for Non-Delivery of Pictures
Thank you for filling out this form. Please mail form to address below. We will
check the status of your order and delivery. Once we have received confirmation
that the package never reached your residence, we will send you pictures
immediately. Please allow up to three (3) weeks.

Student Name:______________________________________________________

Package AMC proof number __________________________________________

Your Name: ________________________________________________________

Date ordered: _______________________________________________________

Package ordered _____________________________________________________

Total amount paid: $_____________________________

Mailing Address (Street) _______________________________________________

                   City:  ________________________________________________

                    State:  _______________________________________________

                      Zip:  _______________________________________________

Day Phone Number:  (____)__________- _______________

Evening Phone Number:  (____)__________- _______________   

E-mail:_____________________________________________________

Type of delivery:

SCHOOL ORDER:
Have you filed a claim at your Parent coordinator office?
     YES                                      NO
ONLINE or MAIL ORDER:
Have you filed a claim form at the United States Postal Service regarding your lost mail?
     YES                                     NO

I hereby confirm that I have not received the picture(s) I ordered and I have not filed a governmental claim
through the United states Postal Service.

_______________________________                               _________________________
Signature                                                                                                 Date

Mail Claim Form to:     
AMC PHOTO Inc., P.O.Box 740-304, Rego Park, NY 11374