Check Consolidation Vendor Setup Form

EXHIBIT C

Dear AIG Partner:

Enclosed are documents required to enroll in the AIG Check Consolidation Program. Once enrolled in this program, AIG will consolidate the claim payments due to you into bi-weekly direct deposits to your bank account, eliminating the current system of multiple monthly claims payments. Payments will be processed the first business days after the first and the fifteen day of the month and will arrive in your firm’s bank account approximately one to two days after processing.

This program benefits both you and AIG by streamlining your bookkeeping, simplifying your firm’s accounts receivable and providing administrative efficiencies to AIG through elimination of numerous small payments.

To illustrate the bookkeeping benefits this program will provide you to we have attached a sample Bordereau Report that AIG will provide to assist you in tracking the payments that have been consolidated in a particular payment.

Kindly submit the completed enrollment form directly to Litigation Support via the Litigation Support Request Form.

Thank you for your consideration. ADD EDIT DELETE A I G C H E C K C O N S O L I D A T I O N V E N D O R S E T U P

IS THIS VENDOR A MEDICAL PROVIDER YES NO

VENDOR TAX ID#:

VENDOR NAME:

VENDOR PLAN #: (AIG WILL PROVIDE)

VENDOR BANK #:

VENDOR BANK ACCT #:

ACCOUNT TYPE: Corporate Checking Corporate Savings REFERENCE: AIG Consolidated Payment E-MAIL ADDRESS: (40 CHARACTER LIMIT)

2 SUBMITTED BY:

DATE SUBMITTED

SAMPLE