Information Request/Release

DHI Cooperative Inc.

P.O. Box 28168

Columbus, OH 43228

Fax 614-545-0468, Phone 1-800-DHI-OHIO

E-mail- bwinters@dhiohio.com

Release information on the following herd: Bill To: (check one)

Date: ________________________ Herd: ______

Herd code: ___________________ Consultant: ______

Farm Name: ___________________________________________ Other: ______

If other furnish details in notes section

Primary contact at farm: __________________________________

Approved by: ___________________________________________ Required

Send information to the following:

Name: ______________________________

Company: ___________________________ Street Address: ____________________________________

City: __________________ State: ____________________ Zip code: _____________

E-mail Address: __________________________________ Fax Number: ______-______-________

Phone Number: ____-_____-________

Information Requested: Check all that apply

Excel Spreadsheet File ____ CTAP Load Files _____ ProGRASP Load Files _____ Other file (specify below) _____

Any other report(s) processed at Columbus: ____________________ _____________________ ______________________

Delivery Method-E-mail is preferred delivery method

Fax (reports only) _____ E-mail ______ Diskette (files only) ______

Notes:

Please Fax or mail this back to DHI Cooperative Inc. at the address above.