Letter of Authority for a Reconsignment 801-355-6880 FROM FAX#_____________________________________________ PRO#_ _______________________________________________ TO FAX#_870-391-2587 ______________________________________________ IS TO BE RECONSIGNED TO THE FOLLOWING LOCATION: Purestream Technology COMPANY NAME:_________________________________________________________________________________________________ 2685 North Main ADDRESS:_______________________________________________________________________________________________________ North Logan, UT 84341 CITY-STATE, ZIP:__________________________________________________________________________________________________ ■ Economy NEW SHIPMENT TO MOVE AS p Priority p _ CHARGES ON THE ORIGINAL BILL WERE ______ PPD OR ______ COL IF PPD: CHARGES WILL BE PAID ON THE ORIGINAL PRO IF COL: CHARGES WILL BE ADVANCED TO NEW PRO IF A NEW PRO IS CUT, OTHERWISE RECONSIGNMENT CHARGES WILL BE COLLECTED ON THE ORIGINAL PRO. WHO WILL BE RESPONSIBLE FOR THE ORIGINAL FREIGHT CHARGES? Purestream Technology _______________________________________________________________________________________________________________ Company Name 510 S. 600 E, Salt Lake City, UT 84102 _______________________________________________________________________________________________________________ Company Address RESPONSIBLE PARTY FOR THE RECONSIGNMENT CHARGES, STORAGE CHARGES, OR ANY OTHER ACCESSORIAL CHARGES: _ Purestream Technology COMPANY NAME:_________________________________________________________________________________________________ 510 S. 600 E ADDRESS:_______________________________________________________________________________________________________ Salt Lake City, UT 84102 CITY-STATE, ZIP:__________________________________________________________________________________________________ SPECIAL INSTRUCTIONS:___________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Todd Whiting PRINTED NAME:__________________________________________________________________________________________________ SIGNATURE:_ __________________________________________________ 5-16-12 DATE:__________________________________________ Purestream Technology COMPANY NAME:_________________________________________________________________________________________________ 702-336-4731 TELEPHONE NUMBER:_ ____________________________________________________________________________________________ CC208/811