Items 4A and 4B are for KCCO’s use only.
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Fld Name / |
Instruction |
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Instructions
to Complete Form CCC-330 |
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1 Organiza- tion’s IRS Tax ID No. |
Enter organization’s Internal Revenue Service (IRS) Tax Identification Number. |
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2 Name of Organiza-tion |
Enter organization’s
complete legal name. |
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3 Organiza- tion’s Address |
Enter organization’s main address or address of ‘parent’ company including zip code. |
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4 Name of Organiza-tion |
Enter name of organization’s contact person vested with authority to enter into this agreement. |
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5 Contact Person’s Telephone Number |
Enter the organization’s contact person’s telephone number including area code. |
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Part E |
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3A Name of Nonprofit Organiza- tion |
Enter same organization’s name listed in Item 2. |
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3B Signature of Nonprofit Organiza- tion’s Represen-tative |
Enter the signature of the representative of the organization vested with authority to enter into this agreement. This must be the same person as Item 4. |
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3C Title of Nonprofit Organiza- tion’s Represen- tative |
Enter title of person vested with authority to enter this agreement. |
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3D Date Signed |
The representative of the nonprofit organization by signing and dating this form certifies that the data entered on this form are true and correct to the best of his or her knowledge and belief. If you are mailing or faxing this form, print the form and manually enter your signature. |
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Items 4A and 4B are for KCCO’s use only. |
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Fld Name / |
Instruction |
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Instructions for FORM CCC-330A |
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1 Organiza- tion’s IRS Tax ID Number |
Enter organization’s Internal Revenue Service (IRS) Tax Identification Number. Same as Item 1 on form CCC-330. |
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2A Contact Person’s Name and Telephone Number |
Enter name of organization’s contact person name vested and telephone number including area code with authority to submit orders. |
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2B Organiza- tion’s Name and Address |
Enter organization’s complete legal name and main address or address of parent organization including zip code. |
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2C Organiza- tion’s Telephone Number |
Enter organization’s telephone number including area code. |
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2D Organiza- tion’s Fax Number |
Enter organization’s FAX number including area code. |
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2E Organiza- tion’s E-Mail Address |
Enter organization’s E-mail address or E-mail address of contact person. |
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3A Contact Person’s Name and Telephone Number |
Enter warehouse or receiving point contact person’s name and telephone number including area code. |
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3B Receiving Point’s Name and Address |
Enter warehouse or receiving point name and address including zip code where INDM or Exchange Products will be received. |
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Fld Name / |
Instruction |
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3C Receiving Point’s Telephone Number |
Enter warehouse or receiving point telephone number including area code where INDM or Exchange Products will be received. |
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3D Receiving Point’s Fax Number |
Enter warehouse or receiving point FAX number including area code. |
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3E Receiving Point’s E-Mail Address |
Enter warehouse or receiving point E-mail address or E-mail address of warehouse or receiving point contact person. |
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4B Number of Truckloads |
Enter the total number of truckloads of INDM desired on this form. |
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4C(1) 1st Half Delivery Date |
Enter the date (MM-DD-YYYY) of the 1st to the 15th (first half) of the month when you want delivery made. Delivery will occur between the first and fifteenth of the month. |
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4C(2) Number of Truckloads 1st Half |
Enter number of truckloads you want delivered on the date in Item 4C(1). |
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4C(3) 2nd Half Delivery Date |
Enter the date (MM-DD-YYYY) of the 16th to the 31st (second half) of the month when you want delivery made. Delivery will occur between the sixteenth and thirty-first of the month. |
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4C(4) Number of Truckloads 2nd Half |
Enter number of truckloads you want delivered on the date in Item 4C(3). |
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5A |
Available Exchange Products |
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5B Supplier(s) Name |
Enter the name(s) of the supplier(s) you wish to use from
the catalog listing of eligible suppliers.
(Space is available for the name(s)
of three different suppliers.) |
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Fld Name / |
Instruction |
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5C Pack Size |
Enter the pack size desired from the respective supplier(s). |
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5D Number of Truckload NDM 25 kg |
Enter the number of NDM Truckloads being requested for exchange. |
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5E Exchange Ratio Per Pound |
List the exchange ratio as provided to you by the supplier or from the catalog listing. |
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5F Truckload of Product(s) |
Number of truckloads of the Product, based on supplier information. |
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5G Total Pounds of Products |
Total number of pounds of products, (NDM pounds divided by exchange ratio = Product pounds). For example, 41,327 lbs. (one NDM truckload) divided by 1.3 = 31,790 lbs of Product. |
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6A Signature of Requester |
Signature of person authorized to place orders for NDM. Must be the same person as Item 4 on Form CCC-330. |
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6B Requester’s Title |
Enter title of the person authorized to place orders for NDM in Item 6A. |
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6C Date Signed |
Enter the name of the representative of the nonprofit organization by signing and dating this form certifies that the data entered on this form are true and correct to the best of his or her knowledge and belief. If you are mailing or faxing this form, print the form and manually enter your signature. |
Items
7 through 11C are for KCCO use only.
Completed
and signed Form CCC-330A is to be mailed or faxed to: Kansas City Commodity
Office, Dairy & Domestic Operations Division, P.O. Box 419205, Mail Stop
8718, Kansas City, MO 64141-6205, and FAX NO.