ANNUAL RATE & STRUCTURE PROTECTION AGREEMENT
COMPLETION INSTRUCTIONS

1. Before you print the form (Link Below), complete all the fields that are highlighted in yellow.
· If your company is Tax Exempt, Please include your Tax ID number.
· Enter the scale Model & Serial Number and Annual Charge amount listed on your faxed notification form for each scale you wish to protect.

2. Print out the completed form.

3. Sign the form on the “Signed By” line.

4. Attach your payment check to the completed and signed form.

****Very Important****

Please make you check payable to:

Hasler, Inc.
478 Wheelers Farms Rd
Milford, CT 06461

5. Mail your completed form with your check attached to:

**** Very Important ****

The Alternative Mailing & Shipping Solutions
335 Sherwee Drive
Ste 111
Raleigh, NC 27603

6. For you to receive updated rates for the May 12th rate change, your completed form and payment must be received in our office by April 14th 2008.

PROTECTION AGREEMENT FORM
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