Land O'Lakes Purina Feed, LLC Coupon Redemption Form by isv27825

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									                       Land O’Lakes Purina Feed, LLC
                         Coupon Redemption Form
                    Mail completed form and coupons to:

                                 CMS Services
                        Attention: Land O Lakes Purina
                                PO Box 426008
                            Del Rio, TX 78842-6008
                               P: 1-877-322-8355
Date OR Info to identify this form (EX: P0#): ________________

Dealer/member Name: ______________________________________________________

Address: _________________________________________________________________

City: _________________________________           State: ___________ Zip: ___________

Phone: _______________________________

Customer Account Number: ______________ (must be on form to process)

Shipping Plant: ________________________ (must be on form to process)

Dealer/member Signature: ___________________________________________________

Coupon Inventory: Count and total each different coupon (by PE no.) and list below

         Coupon PE #                      Coupon Description                    # of Coupons
  1.

  2.

  3.

  4.

  5.

  6.

  7.

  8.

  9.

 10.

         Coupon Redemption Form MUST accompany coupons
        Keep a copy for your records. DO NOT mail to LOLPF Feed Plant

								
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