ACKNOWLEDGEMENT FORM

I, ______________________________________, have received copies

(Licensed Manager’s name)

of

1. the Commission for the Blind’s Vending Program Rules and Regulations, ____________________________

2. the Operating Agreement for the facility to which I have been assigned, ______________________________

3. and the Permit with the Property Managing Agency of the facility to which I have been assigned. __________

__________________________________________________ ________________

Licensed Manager’s Signature Date

______________________________________ Date ________________

S.L.A. Staff

[4/15/97; Recompiled 10/01/01]