C.A.R.E.
Program Award Redemption Form

DISCLAIMER: University of Michigan guidelines state that program points may not be redeemed for any item considered to be a weapon or an accessory to a weapon (hunting knives, gun scopes, etc.).

Required fields are  yellow .

Last Name:    First Name:

Department:

Item Code:

Enter the item description below: If the item you have chosen offers a color option, please enter your preference below. You may want to enter a second choice also, in case your first color isn't available. If no color is specified, the default color will be ordered. Number of points to redeem: If you do not know your available points, write "use available points" and the required number of points will be redeemed from your CARE account. (You may choose to record the redemption date and item order number on your paper coupons, if you have them, and save them for your records.)

Date Ordered:

I'd like my order delivered directly to my home. Street Address: City: State: Zip:

I'd like my order delivered to 109 E. Madison and have you contact: me     my supervisor Employee phone:    Supervisor's name: Employee email:     Supervisor's phone:

Comments:

Content modified: March, 2007

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