Date:__________________
USDA Standards____________

Private Type_______________ Mark_________________

Check quality factors for arbitration:

HVI CLASSMANUAL CLASS_____Length_____Color Grade_____Strength_____Leaf Grade_____Uniformity_____Color and Leaf against type______________Color Grade_____Leaf Grade_____Micronaire_____All HVI Factors

Name and address of Company Submitting Samples:
________________________________________________
________________________________________________
________________________________________________

List name, address, and fax number for firms to receive arbitration results

A._______________________________ B.__________________________________
_________________________________ ____________________________________
_________________________________ ____________________________________

Fax_____________________________ Fax________________________________

Do you want the samples returned?_____YES_____NO If yes, firm name and address:
_________________________________________
_________________________________________
_________________________________________

Shipping company to use:____________________________ Account No.__________________

Signature of person submitting samples:_________________________________________
Submit request, tag list, and samples to:

USDA, AMS
Cotton Division
Quality Control Section 3275 Appling Road
Memphis
Tennessee 38133

SMR Request for Arbitration Form