CHAIN-OF-CUSTODY VERIFICATION

Supplier Company Name _____________________________________

Contact Person ________________________    Title __________________

Address _________________________________________________

Phone ___________________    E-Mai l_______________________

Instructions:

1. Name of product we buy from your company
2. List percentage content of:
   Virgin content, Post-consumer recycled content (PCR),
   Pre-Consumer recycled content (R), Agricultural residue or fiber (AF)
   FSC-certified fiber (FSC)
3. Name all companies supplying virgin wood fiber for this product.
4. List all forest operation locations that supply virgin wood fiber for this product.
5. Do any of these forest operations harvest ancient forests or old growth trees?
6. Totally chlorine free, recycled/processed chlorine free, chlorine bleached?
   What are the resins/solvents used in the production of this product?
7. Signature, title, date and phone of manufacturer’s representative,
   verifying accuracy, if supplier is not also manufacturer.

A Product B Content C Virgin Wood/ Fiber Suppliers D Forest Location E Old Growth F Bleaching Process/ resins/ solvent G Manufacturer’s Verification Example: Best Copy Paper 30% PC Johnson Paper Company (mfr) Johnson Forestry (virgin wood supplier) Oregon Blue Mountain Forest, 2nd growth No old growth Recycled Chlorine Free (signature) Joe Johnson, President October 1, 1999 123/456-7890

I certify that every reasonable effort has been made to obtain the requested information and that the information provided above is complete and accurate to the best of my knowledge.

Printed Name _________________________   Signature __________________________

Title _____________________________    Date _____________________