Source_List_Application.pdf

If former military or Exchange employee indicate separation date:

TYPE OF OWNERSHIP: (check only where the contract is to be performed in the United States, its possessions and Puerto Rico)

MINORITY BUSINESS ENTERPRISE

(see definition below & check appropriate box)

SMALL DISADVANTAGED BUSINESS

(see definition below)

INDICATE IF OWNER OR OFFICER IS ACTIVE

MILITARY, U.S. GOVERNMENT EMPLOYEE, OR

RETIRED REGULAR ARMY/AIR FORCE OFFICER.

INDICATE IF AN OWNER OR OFFICER IS AN

IMMEDIATE FAMILY MEMBER OF ONE OF

ABOVE LIVING IN SAME HOUSEHOLD, AND

PROVIDE (1) NAME, (2) RANK/GRADE, (3)

RELATIONSHIP, (4) JOB TITLE, (5)

ORGANIZATION/AGENCY AND (6) LOCATION.

(Use separate sheet or reverse side)

INDICATE IF AN OWNER OR OFFICER OF THE

FIRM OR THE FIRM OR A RELATED FIRM HAS

BEEN CONVICTED OF A FELONY RELATED TO

A BUSINESS TRANSACTION, OR HAS BEEN

SUSPENDED OR DEBARRED.

SECTION I - GENERAL

ARMY & AIR FORCE EXCHANGE SERVICE

SOURCE LIST APPLICATION

TO: (enter name & address of Exchange purchasing activity) DATE

INITIAL APPLICATION

REVISED APPLICATION

This is an application to be added to the Exchange source file to provide the merchandise, food, supplies, equipment, services or construction indicated herein. Send an application to all Exchange activities where you desire to be included in the source file. The application must be signed by an officer of your firm. If you fail to respond to solicitations or presolicitation notices it will be understood by the Exchange to indicate lack of interest and concurrence in the removal of your name from the source files for the items/services concerned.

SECTION II - SOURCE FILE DATA

FIRM NAME & ADDRESS (enter complete address, including zip code, actual street address preferred)

PERSON(S) AUTHORIZED TO COMMIT YOUR FIRM CONTRACTUALLY

NAME TITLE

a.

b.

c.

E-MAIL: (required)

SECTION III - CERTIFICATION

I certify that the information given above is correct and that owners, officers, and related firms are not now suspended or debarred by any agency of the U.S. Government.

NAME AND TITLE (print or type) SIGNATURE

SECTION IV - CATEGORIES OF MERCHANDISE, FOOD, SUPPLIES, EQUIPMENT, SERVICES & CONSTRUCTION

Indicate on the reverse side the categories of items, services or construction that you are interested in providing to the Exchange.

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) ESR 65-1

TIN NO.

ADDRESS TO WHICH SOLICITATIONS ARE TO BE MAILED

(If different from above)

SMALL BUSINESS

YES NO

TOTAL SALES FOR LAST

TWELVE MONTHS

YES NO

YES NO

YES NO

TYPE OF BUSINESSTYPE OF ORGANIZATION

WOMEN-OWNED BUSINESS

(see definition below)

OTHER

The term "minority business" means a business concern (1) which is at least 51 percent owned by minority group members; or in the case of any publicly owned business, at 51 percent of the stock of which is owned by one or more minority group members (2) whose management and daily business operations are controlled by one or more such minority group members. For purposes of this definition, minority group members include

Black Americans, Hispanic Americans, Asian-Pacific American, Asian-Indian Americans, and Native Americans (such as American Indians, The term "women-owned business" means a business that is at least 51 percent owned by a woman or women who also control and operate it. "Control" in this context means exercising the power to make policy decisions. "Operate" in this context means being actively involved in the day-to-day management.

The term "small disadvantaged business" means a small business concern which is at least 51% unconditionally owned by one or more individuals who are both socially and economically disadvantaged, or a pubically owned business that has at least 51% of its stock unconditionally owned by one or more socially or economically disadvantaged individuals.

DUNS NO.

TELEPHONE NO. FAX NO.

INDIVIDUAL

PARTNERSHIP

OTHER (specify):

OTHER (specify):

REGULAR DEALER

SERVICE ESTABLISHMENT

CONSTRUCTION FIRM

MANUFACTURER OR PRODUCER

CORPORATION, INCORPORATION

IN THE STATE OR COUNTRY OF

5. Other (specify below):

SECTION IV-A - MERCHANDISE, FOOD, SUPPLIES & EQUIPMENT

List the items you wish to sell to the Exchange. You may attach a separate listing, and/or catalogs, as needed:

SECTION IV-B - SERVICES AND CONSTRUCTION

Indicate below the categories of services or construction you are interested in providing. Also indicate on an attached sheet or in the remarks section below the geographical areas/installations you are interested in serving.

SERVICES

1. Customer Related Services:

Barber Shops Beauty Shops Laundry and Dry Cleaning Clothing Alterations Optical Optometry

Floral Service (Shop/Wire) Watch/Jewelry Repair Shoe Repair

Pet Grooming Custom Picture Framing

Photographic Processing Portrait Studio

Pictorial Review/Yearbook Garage/Auto Repair Car/Trailer Rental

Equipment/Appliance Rental

Radio/Television/Appliance Television Rental

Repair Bicycle/Small Motor and

Lawn Mower Repair Living Quarters Cleaning/ Lawn Care

Miniature Golf

Tailor-Made/Made-to-Measure Military Uniforms/Clothing

Specialty Type Services (key-making, bronzing, engraving, monogramming, trophies, plaques, etc.): (list)

Sale of Handicraft/Paintings Items: (list)

Other: (list) Telecommunications Services Dental

2. Food Services:

Theater Refreshment Stand Mobile Ice Cream/Sno-Cones Mobile Food Service - Pizza/ Fried Chicken Specialty Food Service

Facility - Pizza/Fried Chicken Snack Bar - Sandwiches/

Short Orders

Other: (list)

3. Vending Services:

Soft Drinks - Bottle/Can/Cup Beer (vending machine rental and service only) Full-Line (hot and cold cup beverages, juices, hot and cold food, pastry, chips, candy, cigarettes, etc.)

Cigarette/Cigars Bulk (candy, gum balls, nuts, novelties, etc.)

Postage Stamps

Ice Prophylactics/Sanitary

Napkins Lockers Launderette (washers, dryers, dry cleaners, and soap and bleach dispensers)

Pinball/Games/Pool Tables/ Music Machines/Scales Massage Chairs

Optical Other (list)

4. Support Services (Used by the Exchange):

Vehicle (Cars/Trucks/Trailers)

Repair and Maintenance MHE Repair and Maintenance Heating/Air Conditioning/

Refrigeration Equipment Repair and Maintenance

Office Machine Repair and Maintenance

Service Station Equipment Janitorial Services

Security Guard Services Armored Car/Courier Services Linen/Uniform Rental

Rental/Lease of Trucks/ Tractor Trailers

MHE Rental Refuse Collection

Other: (list)

CONSTRUCTION

A. TYPE CONTRACTOR:

1. General

2. Electrical

3. Mechanical

4. Plumbing

B. TYPE CONSTRUCTION:

1. New

Renovation

C. DOLLAR VALUE:

1. Under $200,000

2. Over $200,000

SECTION V - REMARKS

(REVERSE EXCHANGE FORM 4200-010)

Item Item Item

SERVICES LISTINGS

Automotive Service Concession Auto Detailing Stereo/Alarm Installation Window Tinting/Windshield Repair Auto Parts Store Car Care Center Quick Lube Center Other (Specify)

Commodity Concession Arts and Crafts Book Stores Brass/Bronze/Pewter/Metal ware Candy - Boxed/Bulk Cards/Comics China/Ceramics/Pottery Christmas/Seasonal Clothing/ Accessories/T-Shirts Crystal/Glassware Dolls/Toys Encyclopedia Sales Family Histories Furniture Giftware/Collectables/Souvenirs Gold/Jewelry Leather goods Nutrition Center Office Supply Paintings/Prints/Posters Plaques/Trophies Sports Merchandise Other (Specify)____________________________

Vending Concession Amusement/Pinball/Video/Games Bulk/Novelties Vending Bulk Water Car Vacuum/Car Wash Coin Operated Digital Photo Printing DVD/Movie Rental Energy/Sport/Isotonic Drinks Full Line Vending Ice Cream/Frozen Food Kiddie Rides Laundromat Locker Vending Newspaper Vending Popcorn Vending Prophylactic/Sanitary Napkin Recycle/Reverse Vending Soft Drink Vending - Bottle/Can/Cup Soap/Bleach Dispenser

Stamps Other (Specify)____________________________

Health Services Audiology Dental Clinic Massage Therapy Optical Shop Optometry Clinic Pharmacy Other (Specify)____________________________

Services Concession Alterations Appliance Repair Barber Beauty Business Center Car Rental Carnival Computer/Electronics Repair Custom Picture Framing Day Spa Embroidery/Monogramming Service Engraving/Trophy/Plaques Equipment & TV Rental Equipment Repair Flower Shop Formal Wear Rental/Sales Furniture Rental Gift Wrap Services Housekeeping Infant Photography Laundry/Dry Cleaning Locker Storage/Warehouse Nail Salon Pack and Wrap Pet Shop/Pet Grooming Photo Processing/1 Hr Photo Portrait Studio/Painting/Sketching Shoe Repair Tailor Made Clothing Taxi/Shuttle Truck/Trailer Rental T-Shirts/Personalized Clothing Unit Photography/Year Book Video Rental Watch/Jewelry Repair Other (Specify)____________________________

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 3

Optical

SERVICES LISTINGS

Food Concession Services Asian Food Bagel Shop Bakery Barbecue Hamburgers/Hotdogs Candy Shop Chicken Coffee/Espresso Shop Cookie Shop Deli Shop Donuts Frozen Yogurt Ice Cream Juice/Smoothie Bar Kebab/Gyro Mobile Food Mobile Ice Cream Pizza Sandwich Snack Bar Snow Cones/Shave Ice Other (Specify)____________________________

Telecommunications Services Cable TV Service Communication Center Internet Services Long Distance Phone Services Pre-Paid/Debit Telephone Cards Satellite TV Services Telephone, Coin Operated Telephone, Residential – Local & LD Wireless – Cellular or PCS Services Other (Specify)____________________________

Support Services Bicycle Assembly/Repair Delivery Service Equipment/Merchandise Repair Janitorial Linen/Uniform Rental Printing Ring Sizing/Jewelry Repair Security Guard Other (Specify)____________________________

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 4

LOCATION LISTINGS-CONUS

CONUS Continental United States All CONUS Locations Alabama Fort McClellan Gunter Air Force Base Maxwell Air Force Base Redstone Arsenal Fort Rucker Alaska Eielson Air Force Base Elmendorf Air Force Base Fort Greely Fort Richardson Fort Wainwright Arizona Davis-Monthan Air Force Base Fort Huachuca Luke Air Force Base Yuma Proving Ground Arkansas Little Rock Air Force Base Pine Bluff Arsenal California Beale Air Force Base Edwards Air Force Base Fort Hunter-Liggett Fort Irwin Los Angeles Air Force Base Los Alamitos AFRC March Air Force Base McClellan Air Force Base Onizuka Air Force Station Presidio of Monterey Camp Parks Camp Roberts Sharp Army Depot Camp San Luis Obispo Travis Air Force Base Vandenberg Air Force Base Colorado USAF Academy Buckley AFB Fort Carson Peterson Air Force Base Delaware Dover Air Force Base District of Columbia Andrews Air Force Base Bolling Air Force Base Fort McNair U.S. Soldier’s & Airmen’s Home Walter Reed Army Medical Center Florida Eglin Air Force Base Homestead Air Force Base Hurlburt Field MacDill Air Force Base

Patrick Air Force Base Southern Command HQ Tyndall Air Force Base Georgia Fort Benning Dobbins Air Force Base Fort Gillem Fort Gordon Hunter Air Force Base Fort McPherson Moody Air Force Base Robins Air Force Base Fort Stewart Hawaii Aliamanu Military Reservation Bellows Air Force Station Hickam Air Force Base Helemano Military Reservation Pohakuloa Military Reservation Schofield Barracks Fort Shafter Tripler Army Medical Center Wheeler Air Force Base Idaho Gowen Field Mountain Home Air Force Base Illinois Rock Island Arsenal Scott Air Force Base Indiana Fort Benjamin Harrison Kansas Fort Leavenworth McConnell Air Force Base Fort Riley Kentucky Fort Campbell Fort Knox Louisiana Barksdale Air Force Base Fort Polk Maryland Aberdeen Proving Ground Fort Detrick/Site R Fort George G. Meade Site R/Raven Rock Complex Warfield Air National Guard Massachusetts Cape Cod AFS Hanscom Air Force Base Natick Lab Westover Air Force Base Michigan Battle Creek Air National Guard Selfridge Air National Guard

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 5

LOCATION LISTINGS-CONUS

Minnesota Camp Ripley Twin Cities Air National Guard Mississippi Columbus Air Force Base Keesler Air Force Base Missouri Fort Leonard Wood Richards-Gebaur Air Force Station Whiteman Air Force Base Montana Malmstrom Air Force Base Nebraska Offutt Air Force Base Nevada Nellis Air Force Base New Hampshire Pease Air National Guard New Jersey Fort Dix/McGuire Air Force Base Fort Monmouth Pomona ANG New Mexico Cannon Air Force Base Holloman Air Force Base Kirtland Air Force Base White Sands Missle Range New York Fort Drum Griffiss Air Force Base Fort Hamilton Hancock Field Niagara Air Force Station Stewart Air National Guard U.S. Military Academy North Carolina Fort Bragg/Pope AFB Seymour Johnson Air Force Base North Dakota Camp Grafton Grand Forks Air Force Base Minot Air Force Base Ohio Wright Patterson Air Force Base Oklahoma Altus Air Force Base Fort Sill Tinker Air Force Base Tulsa Air National Guard Vance Air Force Base Oregon Kingsley Field Pennsylvania Charles E. Kelly Carlisle Barracks Fort Indiantown Gap Army Depot Tobyhanna Army Depot

South Carolina Charleston Air Force Base Fort Jackson Shaw Air Force Base South Dakota Ellsworth Air Force Base Tennessee McGhee Tyson Air National Guard Texas Fort Bliss Brooks Air Force Base Dyess Air Force Base Goodfellow Air Force Base Fort Hood Laughlin Air Force Base Lackland Air Force Base Camp Mabry NAS JRB Fort Worth Randolph Air Force Base Fort Sam Houston Sheppard Air Force Base Utah Fort Douglas Hill Air Force Base Virginia Fort A.P. Hill Fort Belvoir Fort Eustis Langley Air Force Base Fort Lee Fort Monroe Fort Myer Fort Story Washington Fairchild Air Force Base Fort Lewis McChord Air Force Base Vancouver Barracks Yakima Firing Center Wisconsin Fort McCoy Volk Field Wyoming F.E. Warren Air Force Base Off Shore Honduras Puerto Rico Haiti

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 6

LOCATION LISTINGS - EUROPE

EUROPE

All Europe Locations Afghanistan Afghanistan Azores Azores Belgium Chievres Bosnia Bosnia Croatia Croatia Egypt Egypt England Alconbury Croughton Fairford Feltwell Lakenheath Menwith Hill Mildenhall Molesworth Germany Ansbach Bamberg Darmstadt Dexheim Friedberg Garmisch Giessen Grafenwoehr Hanau Hohenfels Illeshiem Kaiserslautern Katterbach Landstuhl Mainz-Kastel Ramstein Sembach Spangdahlem Stuttgart Schweinfurt Vilseck Vogelweh Wackerheim Wiesbaden Wuerzburg Hungary Hungary Iraq

Italy Aviano Ghedi Livorno Vicenza Kosovo Kosovo Kuwait Kuwait Kyrgzstan Kyrgzstan Macedonia Macedonia Netherlands Schinnen Saudi Arabia Riyahd Turkey Adana Incirlik Izmir Qatar Qatar

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 7

LOCATION LISTINGS-PACIFIC

PACIFIC

All Pacific Locations Guam Anderson AB Japan Camp Fuji Camp Zama Misawa Sagamihara Yokota Korea Peninsula Camp Carroll Camp Casey Camp Eagle Camp Henry Camp Hovey Camp Humphreys Camp Jackson Camp Long Camp Market Camp Red Cloud Camp Stanley Camp Walker Chinhae K-16 K-2 Osan AB Pohang (Camp Muchuk) Rodriguez Range Suwon AB Yongin Yongsan/Cp Kim/Hannam Okinawa Camp Courtney Camp Foster Camp Hansen Camp Kinser Camp Lester Camp Schwabb Camp Shields Kadena AB MCAS Futenma McTureous Naha Port Torii Station

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Page 8

Printing \\\\Dev2\\m2 shared\\...\\FRPsĐ0_010.FRP Administrator D:20020930192738Z D:20031119154028- 06'00' If former military or Exchange employee indicate separation date:

TYPE OF OWNERSHIP: (check only where the contract is to be performed in the United States, its possessions and Puerto Rico)

MINORITY BUSINESS ENTERPRISE

(see definition below & check appropriate box)SMALL DISADVANTAGED BUSINESS (see definition below) INDICATE IF OWNER OR OFFICER IS ACTIVE MILITARY, U.S. GOVERNMENT EMPLOYEE, OR RETIRED REGULAR ARMY/AIR FORCE OFFICER.

INDICATE IF AN OWNER OR OFFICER IS AN IMMEDIATE FAMILY MEMBER OF ONE OF ABOVE LIVING IN SAME HOUSEHOLD, AND PROVIDE (1) NAME, (2) RANK/GRADE, (3) RELATIONSHIP, (4) JOB TITLE, (5) ORGANIZATION/AGENCY AND (6) LOCATION.

(Use separate sheet or reverse side) INDICATE IF AN OWNER OR OFFICER OF THE FIRM OR THE FIRM OR A RELATED FIRM HAS BEEN CONVICTED OF A FELONY RELATED TO A BUSINESS TRANSACTION, OR HAS BEEN SUSPENDED OR DEBARRED.

SECTION I - GENERAL

ARMY & AIR FORCE EXCHANGE SERVICE

SOURCE LIST APPLICATION

TO: (enter name & address of Exchange purchasing activity)

DATE

INITIAL APPLICATION

REVISED APPLICATION

This is an application to be added to the Exchange source file to provide the merchandise, food, supplies, equipment, services or construction indicated herein. Send an application to all Exchange activities where you desire to be included in the source file. The application must be signed by an officer of your firm. If you fail to respond to solicitations or presolicitation notices it will be understood by the Exchange to indicate lack of interest and concurrence in the removal of your name from the source files for the items/services concerned.

SECTION II - SOURCE FILE DATA

FIRM NAME & ADDRESS (enter complete address, including zip code, actual street address preferred)

PERSON(S) AUTHORIZED TO COMMIT YOUR FIRM CONTRACTUALLY

NAME

TITLE

a.

b.

c.

E-MAIL:

(required)

SECTION III - CERTIFICATION

I certify that the information given above is correct and that owners, officers, and related firms are not now suspended or debarred by any agency of the U.S. Government.

NAME AND TITLE (print or type)

SIGNATURE

SECTION IV - CATEGORIES OF MERCHANDISE, FOOD, SUPPLIES, EQUIPMENT, SERVICES & CONSTRUCTION Indicate on the reverse side the categories of items, services or construction that you are interested in providing to the Exchange.

EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)

ESR 65-1

TIN NO.

ADDRESS TO WHICH SOLICITATIONS ARE TO BE MAILED (If different from above)

SMALL BUSINESS

YES

NO

TOTAL SALES FOR LAST

TWELVE MONTHS

YES

NO

YES

NO

YES

NO

TYPE OF BUSINESS

TYPE OF ORGANIZATION

WOMEN-OWNED BUSINESS

(see definition below)

OTHER

The term "minority business" means a business concern (1) which is at least 51 percent owned by minority group members; or in the case of any publicly owned business, at 51 percent of the stock of which is owned by one or more minority group members (2) whose management and daily business operations are controlled by one or more such minority group members. For purposes of this definition, minority group members include Black Americans, Hispanic Americans, Asian-Pacific American, Asian-Indian Americans, and Native Americans (such as American Indians, The term "women-owned business" means a business that is at least 51 percent owned by a woman or women who also control and operate it. "Control" in this context means exercising the power to make policy decisions. "Operate" in this context means being actively involved in the day-to-day management.

The term "small disadvantaged business" means a small business concern which is at least 51% unconditionally owned by one or more individuals who are both socially and economically disadvantaged, or a pubically owned business that has at least 51% of its stock unconditionally owned by one or more socially or economically disadvantaged individuals.

DUNS NO.

TELEPHONE NO.

FAX NO.

5.

Other (specify below):

SECTION IV-A - MERCHANDISE, FOOD, SUPPLIES & EQUIPMENT

List the items you wish to sell to the Exchange. You may attach a separate listing, and/or catalogs, as needed:

SECTION IV-B - SERVICES AND CONSTRUCTION

Indicate below the categories of services or construction you are interested in providing. Also indicate on an attached sheet or in the remarks section below the geographical areas/installations you are interested in serving.

SERVICES

1. Customer Related Services:

Barber Shops Beauty Shops Laundry and Dry Cleaning Clothing Alterations Optical Optometry Floral Service (Shop/Wire) Watch/Jewelry Repair Shoe Repair Pet Grooming Custom Picture Framing Photographic Processing Portrait Studio Pictorial Review/Yearbook Garage/Auto Repair Car/Trailer Rental

Equipment/Appliance Rental

Radio/Television/Appliance Television Rental Repair Bicycle/Small Motor and Lawn Mower Repair Living Quarters Cleaning/ Lawn Care Miniature Golf Tailor-Made/Made-to-Measure Military Uniforms/Clothing Specialty Type Services (key-making, bronzing, engraving, monogramming, trophies, plaques, etc.): (list) Sale of Handicraft/Paintings Items: (list) Other: (list) Telecommunications Services Dental

2. Food Services:

Theater Refreshment Stand

Mobile Ice Cream/Sno-Cones

Mobile Food Service - Pizza/ Fried Chicken Specialty Food Service Facility - Pizza/Fried Chicken Snack Bar - Sandwiches/ Short Orders Other: (list)

3. Vending Services:

Soft Drinks - Bottle/Can/Cup Beer (vending machine rental and service only) Full-Line (hot and cold cup beverages, juices, hot and cold food, pastry, chips, candy, cigarettes, etc.)

Cigarette/Cigars Bulk (candy, gum balls, nuts, novelties, etc.)

Postage Stamps Ice Prophylactics/Sanitary Napkins Lockers Launderette (washers, dryers, dry cleaners, and soap and bleach dispensers) Pinball/Games/Pool Tables/ Music Machines/Scales Massage Chairs Optical Other (list)

4. Support Services (Used by the Exchange):

Vehicle (Cars/Trucks/Trailers) Repair and Maintenance MHE Repair and Maintenance Heating/Air Conditioning/ Refrigeration Equipment Repair and Maintenance Office Machine Repair and Maintenance Service Station Equipment Janitorial Services Security Guard Services Armored Car/Courier Services

Linen/Uniform Rental Rental/Lease of Trucks/ Tractor Trailers MHE Rental Refuse Collection Other: (list)

CONSTRUCTION

A. TYPE CONTRACTOR:

1.

General 2.

Electrical 3.

Mechanical 4.

Plumbing

B. TYPE CONSTRUCTION:

1.

New Renovation

C. DOLLAR VALUE:

1.

Under $200,000 2.

Over $200,000

SECTION V - REMARKS

(REVERSE EXCHANGE FORM 4200-010)

Item Item Item

SERVICES LISTINGS

Automotive Service Concession Auto Detailing Stereo/Alarm Installation Window Tinting/Windshield Repair Auto Parts Store Car Care Center Quick Lube Center Other (Specify)____________________________ Commodity Concession Arts and Crafts Book Stores Brass/Bronze/Pewter/Metal ware Candy - Boxed/Bulk Cards/Comics China/Ceramics/Pottery Christmas/Seasonal Clothing/ Accessories/T-Shirts Crystal/Glassware Dolls/Toys Encyclopedia Sales Family Histories Furniture Giftware/Collectables/Souvenirs Gold/Jewelry Leather goods Nutrition Center Office Supply Paintings/Prints/Posters Plaques/Trophies Sports Merchandise Other (Specify)____________________________

Vending Concession Amusement/Pinball/Video/Games Bulk/Novelties Vending Bulk Water Car Vacuum/Car Wash Coin Operated Digital Photo Printing DVD/Movie Rental Energy/Sport/Isotonic Drinks Full Line Vending Ice Cream/Frozen Food Kiddie Rides Laundromat Locker Vending Newspaper Vending Popcorn Vending Prophylactic/Sanitary Napkin Recycle/Reverse Vending Soft Drink Vending - Bottle/Can/Cup Soap/Bleach Dispenser Stamps Other (Specify)____________________________ Health Services Audiology Dental Clinic Massage Therapy Optical Shop Optometry Clinic Pharmacy Other (Specify)____________________________ Services Concession Alterations Appliance Repair Barber Beauty Business Center Car Rental Carnival Computer/Electronics Repair Custom Picture Framing Day Spa Embroidery/Monogramming Service Engraving/Trophy/Plaques Equipment & TV Rental Equipment Repair Flower Shop Formal Wear Rental/Sales Furniture Rental Gift Wrap Services Housekeeping Infant Photography Laundry/Dry Cleaning Locker Storage/Warehouse Nail Salon Pack and Wrap Pet Shop/Pet Grooming Photo Processing/1 Hr Photo Portrait Studio/Painting/Sketching Shoe Repair Tailor Made Clothing Taxi/Shuttle Truck/Trailer Rental T-Shirts/Personalized Clothing Unit Photography/Year Book Video Rental Watch/Jewelry Repair Other (Specify)____________________________ EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable) Optical

SERVICES LISTINGS

Food Concession Services Asian Food Bagel Shop Bakery Barbecue Hamburgers/Hotdogs Candy Shop Chicken Coffee/Espresso Shop Cookie Shop Deli Shop Donuts Frozen Yogurt Ice Cream Juice/Smoothie Bar Kebab/Gyro Mobile Food Mobile Ice Cream Pizza Sandwich Snack Bar Snow Cones/Shave Ice Other (Specify)____________________________ Telecommunications Services Cable TV Service Communication Center Internet Services Long Distance Phone Services Pre-Paid/Debit Telephone Cards Satellite TV Services Telephone, Coin Operated Telephone, Residential – Local & LD Wireless – Cellular or PCS Services Other (Specify)____________________________ Support Services Bicycle Assembly/Repair Delivery Service Equipment/Merchandise Repair Janitorial Linen/Uniform Rental Printing Ring Sizing/Jewelry Repair Security Guard Other (Specify)____________________________ EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)

LOCATION LISTINGS-CONUS

CONUS Continental United States All CONUS Locations Alabama Fort McClellan Gunter Air Force Base Maxwell Air Force Base Redstone Arsenal Fort Rucker Alaska Eielson Air Force Base Elmendorf Air Force Base Fort Greely Fort Richardson Fort Wainwright Arizona Davis-Monthan Air Force Base Fort Huachuca Luke Air Force Base Yuma Proving Ground Arkansas Little Rock Air Force Base Pine Bluff Arsenal California Beale Air Force Base Edwards Air Force Base Fort Hunter-Liggett Fort Irwin Los Angeles Air Force Base Los Alamitos AFRC March Air Force Base McClellan Air Force Base Onizuka Air Force Station Presidio of Monterey Camp Parks Camp Roberts Sharp Army Depot Camp San Luis Obispo Travis Air Force Base Vandenberg Air Force Base Colorado USAF Academy Buckley AFB Fort Carson Peterson Air Force Base Delaware Dover Air Force Base District of Columbia Andrews Air Force Base Bolling Air Force Base Fort McNair U.S. Soldier’s & Airmen’s Home Walter Reed Army Medical Center Florida Eglin Air Force Base Homestead Air Force Base Hurlburt Field MacDill Air Force Base Patrick Air Force Base Southern Command HQ Tyndall Air Force Base Georgia Fort Benning Dobbins Air Force Base Fort Gillem Fort Gordon Hunter Air Force Base Fort McPherson Moody Air Force Base Robins Air Force Base Fort Stewart Hawaii Aliamanu Military Reservation Bellows Air Force Station Hickam Air Force Base Helemano Military Reservation Pohakuloa Military Reservation Schofield Barracks Fort Shafter Tripler Army Medical Center Wheeler Air Force Base Idaho Gowen Field Mountain Home Air Force Base Illinois Rock Island Arsenal Scott Air Force Base Indiana Fort Benjamin Harrison Kansas Fort Leavenworth McConnell Air Force Base Fort Riley Kentucky Fort Campbell Fort Knox Louisiana Barksdale Air Force Base Fort Polk Maryland Aberdeen Proving Ground Fort Detrick/Site R Fort George G. Meade Site R/Raven Rock Complex Warfield Air National Guard Massachusetts Cape Cod AFS Hanscom Air Force Base Natick Lab Westover Air Force Base Michigan Battle Creek Air National Guard Selfridge Air National Guard EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)

LOCATION LISTINGS-CONUS

Minnesota Camp Ripley Twin Cities Air National Guard Mississippi Columbus Air Force Base Keesler Air Force Base Missouri Fort Leonard Wood Richards-Gebaur Air Force Station Whiteman Air Force Base Montana Malmstrom Air Force Base Nebraska Offutt Air Force Base Nevada Nellis Air Force Base New Hampshire Pease Air National Guard New Jersey Fort Dix/McGuire Air Force Base Fort Monmouth Pomona ANG New Mexico Cannon Air Force Base Holloman Air Force Base Kirtland Air Force Base White Sands Missle Range New York Fort Drum Griffiss Air Force Base Fort Hamilton Hancock Field Niagara Air Force Station Stewart Air National Guard U.S. Military Academy North Carolina Fort Bragg/Pope AFB Seymour Johnson Air Force Base North Dakota Camp Grafton Grand Forks Air Force Base Minot Air Force Base Ohio Wright Patterson Air Force Base Oklahoma Altus Air Force Base Fort Sill Tinker Air Force Base Tulsa Air National Guard Vance Air Force Base Oregon Kingsley Field Pennsylvania Charles E. Kelly Carlisle Barracks Fort Indiantown Gap Army Depot Tobyhanna Army Depot South Carolina Charleston Air Force Base Fort Jackson Shaw Air Force Base South Dakota Ellsworth Air Force Base Tennessee McGhee Tyson Air National Guard Texas Fort Bliss Brooks Air Force Base Dyess Air Force Base Goodfellow Air Force Base Fort Hood Laughlin Air Force Base Lackland Air Force Base Camp Mabry NAS JRB Fort Worth Randolph Air Force Base Fort Sam Houston Sheppard Air Force Base Utah Fort Douglas Hill Air Force Base Virginia Fort A.P. Hill Fort Belvoir Fort Eustis Langley Air Force Base Fort Lee Fort Monroe Fort Myer Fort Story Washington Fairchild Air Force Base Fort Lewis McChord Air Force Base Vancouver Barracks Yakima Firing Center Wisconsin Fort McCoy Volk Field Wyoming F.E. Warren Air Force Base Off Shore Honduras Puerto Rico Haiti EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)

LOCATION LISTINGS - EUROPE

EUROPE

All Europe Locations Afghanistan Afghanistan Azores Azores Belgium Chievres Bosnia Bosnia Croatia Croatia Egypt Egypt England Alconbury Croughton Fairford Feltwell Lakenheath Menwith Hill Mildenhall Molesworth Germany Ansbach Bamberg Darmstadt Dexheim Friedberg Garmisch Giessen Grafenwoehr Hanau Hohenfels Illeshiem Kaiserslautern Katterbach Landstuhl Mainz-Kastel Ramstein Sembach Spangdahlem Stuttgart Schweinfurt Vilseck Vogelweh Wackerheim Wiesbaden Wuerzburg Hungary Hungary

Italy Aviano Ghedi Livorno Vicenza Kosovo Kosovo Kuwait Kuwait Kyrgzstan Kyrgzstan Macedonia Macedonia Netherlands Schinnen Saudi Arabia Riyahd Turkey Adana Incirlik Izmir Qatar Qatar EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)

LOCATION LISTINGS-PACIFIC

PACIFIC

All Pacific Locations Guam Anderson AB Japan Camp Fuji Camp Zama Misawa Sagamihara Yokota Korea Peninsula Camp Carroll Camp Casey Camp Eagle Camp Henry Camp Hovey Camp Humphreys Camp Jackson Camp Long Camp Market Camp Red Cloud Camp Stanley Camp Walker Chinhae K-16 K-2 Osan AB Pohang (Camp Muchuk) Rodriguez Range Suwon AB Yongin Yongsan/Cp Kim/Hannam Okinawa Camp Courtney Camp Foster Camp Hansen Camp Kinser Camp Lester Camp Schwabb Camp Shields Kadena AB MCAS Futenma McTureous Naha Port Torii Station EXCHANGE FORM 4200-010 (REV JUN 12) (Prev Edition Usable)