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CPG # TO: C- BICE REVENUE AND RECOVERY c ® p �. <br /> ,.. <br /> ACCOUNT TRANSMITTAL �./ \\�U//J <br /> ACCOUNT NO. DEPT. NO. 1 2,REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ADM SWEETENERS <br /> C/O NAME GUARANTOR SSN <br /> ARCHER DANIELS MIDLAND CO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> ADM SWEETENERS P.O. BOX 2675 LODI CA 95241-2675 209-339-1252 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4666 FARIES PARKWAY DECATUR IL 62526 1-800-637-5843 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT ni 1p nATF <br /> TFPMnATFB <br /> 13712 HAZMAT I I I I I I I I I I 1 1.7/1 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT FARCE DEPT. NO. DESCRIPTION AMOUNT <br /> NQ <br /> 230 026000.0 Addition Of 1 Chem $15.00 <br /> 10% Late Charge $1.50 <br /> TOTAL $16.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ADM SWEETENERS 209-339-1252 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 350 N GUILD AVE LODI CA 95240 <br /> SPQUSE CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ADM SWEETENERS 209-339-1252 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 350 N GUILD AVE LODI CA 95240 <br /> ATEREPARED BY COL X (creel <br /> lE <br />