Form No. 4 Walla Sweet Onions Special Purpose Shipment Rept.

OMB # 0581-0178
Wal\a Wal\a Sweet Onion Marketing Committee
PO Box 644, Walla Walla, WA 99362
(509)525-1031;Fax (509)522-2038

United States Department of Agriculture
Agricultural Marketing Service
Fruit and Vegetable Programs

Walla Walla Sweet Onion Marketing Committee
Marketing Order No. 956 Form No.4

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SPECIAL PURPOSE SHIPMENT REPORT
NOTE: Completion of this form and its submission to the Walla Walla Sweet Onion MatXeting Committee is MANDATORY if you
have shipped or received Walla Walla sweet onions out of the production area under a Certificate of Privilege.

Completed by 0 SHIPPER 0 RECEIVER (please check applicable box)
Certificate of Privilege No.
Company Name
Contact Name

Fax

Phone

Address
Street

State

City

Shipped To I Received From

Zip Code

Quantity Shipped
(50-lb equiv)

TOTAL
THE RECEIVER OF SWEET ONIONS HANDLED UNDER A CERTIFICATE OF PRIVILEGE IS RESPONSmLE FOR THE
PAYMENT OF THE WALLA WALLA SWEET ONION MARKETING COMMITTEE ASSESSMENT AT THE CURRENT RATE
OF $ 0.21 PER 50 LB. EQUIVALENT. PLEASE ENCLOSE A CHECK OR MONEY ORDER PAYABLE TO THE WALLA
WALLA SWEET ONION MARKETING COMMITTEE FOR: $
The enclosed check/money order is payment in full for assessments owed for all shipments of Walla Walla sweet onions
handled under the Certificate of Privilege during the
marketing year.
(print current year)

Signature

Date

NOTE: This form must be completed and returned, along with any assessment due, to the Walla Walla Sweet
Onion Marketing Committee office within 30 days of the date of last shipment.
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