MICHIGAN WORKERS ' COMPENSATION PLACEMENT FACILITY

P. O. BOX 3337 • LIVONIA, MI 48151-3337

PHONE (734) 462-9600 • FAX (734) 462-9721

Internet WEB Site: www.caom.com • E-Mail: caom@caom.com

March 7, 2000

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CIRCULAR LETTER #159 TO ALL MEMBERS

RE: UPDATED MAILING INSTRUCTIONS -

HOME OFFICE - GENERAL CIRCULAR PERSONNEL

In an effort to update our data base and provide the best service possible, we ask that the following information be supplied. If you are responding for a carrier group, provide the full name of each carrier within your group. Also, if any of the information varies within your carrier group, provide complete information for each by duplicating this form as many times as needed. This information will be used for all correspondence related to home office - general circular reporting.

If any information you provide on this form changes in the future, please notify the Facility as soon as possible so that our data is current and an accurate line of communication in maintained. If you received this form and would like to be removed from the mailing list, attach the mailing label in the area below and mark delete.

Please complete this form by April 15, 2000 and return to:

Margaret Conley, Executive Secretary

Michigan Workers’ Compensation Placement Facility

PO Box 3337

Livonia, MI 48151-3337

Or fax (734) 462-9721

E-Mail address: caom@caom.com

Carrier Name

Mailing Address

City, State, Zip

Street Address

City, State, Zip

Contact Person / Title

Phone Number

Fax Number

E-Mail Address