Prp Ce Usa Order Form

8/31/06

FEDEX GROUND® PACKAGES RETURNS PROGRAM (PRP) ORDER FORM Please complete the form in its entirety and send to [email protected]

NCR FIELD RETURNS Shipping within U.S. and/or within Canada (Y/N): U.S. to Canada or Canada to U.S. (Y/N): Universal Waste Label U.S. domestic (Y/N) Universal Waste Label Canada to U.S. (Y/N) (Has been approved by Environmental Svcs Dept (Y/N)) Please contact Environmental Svcs Dept/Joseph Stearns at 412.262.7306 for prior approval)

Haz Mat Label (U.S. only) (Y/N): (Has been approved by Safety Dept (Y/N)) (Please contact Safety Dept/Scott Kerr at 412.859.5051 for prior approval)

Color of ‘From’ section (default/red):red blue white Min of 500 (Min of 1,000 for Universal Waste) FedEx Standard Overnight® FedEx 2Day® FedEx Ground® No more than 30 characters including spaces per line

Account name: Address 1: Address 2: City:

St:

Prov:

ZIP code:

~ No more than 30 characters including spaces per line

E-MAIL COMPLETED FORM TO [email protected]