NOT VALID UNLESS REPRODUCED ON YOUR LETTERHEAD

To: Mid-Atlantic Group Network of Shared Services

RE: BLOCKHOUSE COMPANY, Contract # 2540

This letter is our designation to be included as a participant in the Mid-Atlantic Group Network of Shared Services agreement under all applicable terms and conditions and supercedes all previous GPO affiliations for this vendor.

It is our understanding that our participation in this agreement shall become effective no later than thirty (30) days after receipt of this authorized letter. MAGNET will notify the vendor/distributor of our intention to purchase.

If product(s) require shipment through a local distributor, please advise the distributor of choice and sales representative's name, if known:

DistributorSales Representative

Signature / Date

Print Name / Title

Facility

Street Address

CityStateZipTelephone

Kindly indicate estimated annual dollar volume