Trading Partner

TRADING PARTNER

CHANGE OF ADDRESS FORM

Send this form along with a cover letter on your new Company letterhead and a W-9 including your company name, new address and tax identification number to the address below.

Thank You!

1. Trading Partner Name: / Vendor # (if known):
2. Old Address (for verification):
City:
State/Province: / Zip / Postal Code:
3. New Remit To Address:
City:
State/Province: / Zip / Postal Code:
4. Accounts Receivable Contact Name:
/ Contact Phone #:
Officer’s Signature:
This signature authorizes Raley’s & Subsidiaries to change the remit to address of the above named Trading Partner.
Date: / Printed Name & Title:

Send your completed form and the documents requested above to:

Fax: 916-376-6899, Attn: Jeanie Hannibal

E-mail:

Mail: Raley’s Accounts Payable

Ms. Jeanie Hannibal

P O Box 15618

Sacramento CA 95852

Thank you!

2/5/2008 Raley’s Change of Address Form