Commonwealth of Pennsylvania - Milk Marketing Board
12700097155Commonwealth of PennsylvaniaMilk Marketing Board2301 North Cameron Street – Room 110Harrisburg, PA 17110-940800Commonwealth of PennsylvaniaMilk Marketing Board2301 North Cameron Street – Room 110Harrisburg, PA 17110-9408717-787-4194FAX -717-783-6492WEB SITE: E-mail: RA-pmmb@ License Year 2020-2021SUBDEALER SURVEYThe Pennsylvania Milk Marketing Board is conducting a review of sales by Subdealers doing business in Pennsylvania. All survey forms are subject to audit. This information is usually available from your supplying dealer. Include all packaged milk and cream products sold “only” in Pennsylvania for the calendar year 2019.SUPPLYING DEALER NAMEDEALER LICENSE NUMBERDEALERCITY, STATETOTAL QUARTS SOLD IN PENNSYLVANIA1.2.3.4.5.Please return this form to the above address by June 15, 2020. You may also submit this information via Fax (717-783-6492) or email (RA-PMMB@). If you have any questions or concerns regarding this survey, please call Cliff Ackman at 717-787-4021. Thank you.Sub-dealer Name: (Print or Type Name)PMMB License Number:Contact Person:Telephone Number: (Authorized Signature) ................
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