PC/FOS - AMERICAN AIRLINES, INC.
AMERICAN AIRLINES AND AMERICAN EAGLE
LINE QUALIFIED CREW ONLY
PAYROLL DEDUCTION AUTHORIZATION

PLEASE PRINT

EMP.NBR:________________ LAST NAME:______________________________FI:___MI:___

STREET:______________________________________________________________________

CITY:________________________________STATE:___________ZIP:____________-______

PASSWORD:___________________________ - NO MORE THAN 10 CHARACTERS

SS#________-_______-___________

Pilot______ Flight Attendant______

American Airlines:_______ Eagle: NA-Executive:_______ MQ-Simmons:_______

American Airlines, Inc.

I direct to you to payroll deduct from my paycheck those reasonable charges for my use of PCFOS. I understand that I will be charged a base monthly charge, a charge for excess connect time beyond the time included in the base monthly charge, a surcharge for access via the various gateways to PCFOS, and sign-up charge for starting to use PCFOS or restarting to use PCFOS after discontinuing PCFOS service.

I understand that the monthly base charge will apply, in full, to the portion of a month in which PCFOS service is activated or terminated. I understand that PCFOS charges are set by the administrator of PCFOS in the Operations Systems Department of American Airlines, Inc.

I direct that my PCFOS service begin ___________, 2______, and that the charges for this service be deducted from my salary in the last pay period of the following month. I direct that the proceeds of this deduction be sent to American Airlines, Inc. for the sole purpose of the recovery of those reasonable charges for PCFOS.

If my employment with you should be terminated, or I should be suspended for any reason, you are directed by me at that time of such suspension or termination, to recoup from all monies due, such amounts as may then be oweing by me for PCFOS use and pay the amount of such deductions to them with instructions to credit the amount to my PCFOS account and any overpayment or balance in my favor to be sent or paid to me.

This deduciton to you is to be given preference over any and all prior ones I may have sent you. You understand that I have the right to cancel or change this direction at any time as to this deduction from my salary, but this direction which I am granting you is to continue until such time as I cancel it in writing to be sent by me to you.

APPLICANTS SIGNATURE____________________________ DATE________

Send or FAX Original to PCFOS - Operations Planning MD 5420 HDQ, OR AMERICAN AIRLINES, P.O. BOX 619616, DFW AIRPORT,TX 75261-9616 817-967-1145(fax)