Program #031009

Name:__________________________________________________

Address:________________________________________________

City:_______________________State:___________Zip:_________

Pin Number:_____________________________________________

(This is the pin number and code sent to you. If you have forgotten your Pin Number, please email Award Headquarters at BOA@spihq.com. Please refer to the Uncle Ben's Premium Point program. Your pin number will be emailed to the email address noted at time of enrollment).

Daytime Phone Number:_______________________________________

Email Address:_______________________________________________

Quantity Of Uncle Ben’s
        Coupons Enclosed:_____________________

        Number Of Boxes:______________________

Mail Your Premium Point Coupons To:
MasterFoodServices Premium Points Program
Award Headquarters
P.O. Box 94529
Cleveland, OH 44101-4529

For your protection, we suggest you send your Coupon Deposit Form and Point Coupons via certified mail, return receipt requested, and insure the package.