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Kroger Spring 2011 Cosmetic Reset TEAM MEMBER Recap and Payment Form
sm within 24 hours of store visit 2. Instructions: 1. Merchandiser must complete the report foras beta* and enter altecap data on*ie at ww* wSB orovide vou wi a "Payment ArthorizaBon Number" that you a write in each day. 3. Mai a copy of this report form

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that bmeiy payment b snportat* to you. Por payment stabs, check your Convergence Web Portal

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lit Date: (required) T M<* Store/Dept Mgr ManagertNanw (requh< c!)t Majhager%1te(required)

Store Name: /\ i~f/? ^ i-^

Number: ^r'/'SA

Date vrartt was compteted: aartTne:

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PoW Time in Store:

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)t Date: (required)

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Store Name:

Number

Date wwk was rampfcted:

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Store Address: rotal Time to Store:

Starttime: \\ :/

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Date wock was completed: EndTftne: Start TTme: /^' :^i

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mins. rrtte(required) t

Store/Dept Mgr Signature (required) t Store Nsme:

Date: (required) t Print Store/D^rt Mgr 1 i Name (required} t Manager's

Number

Store A ddress:

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Lunch:

(R E Q U IR H )

Total Ttote hii Store: ^ /3 his, -

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rsTrtte(required )

Store/Dept My Signatwfe (requited) t Date: (required) t Print Store/Dept W^Manager's

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StoreAddres s:

N um ber

Date woric was completed:

OntaePA *: " I / | (REQUIRE!)

bis. Lunch:

Fotal T im e m S tore:

Store/Dept Mgr Signature (required) t Date: (required) t Print Store/Dept Mgr Manager's Name (required) t Manager's TWe(required) T
By signing above, you are conBrartng the nAxmatton is acoante. ilinaEdandthatlagtmrt reasm that 1 was unable ttmropte my agigrn<rt as drert^lote^ (hoffine: e66-2<128). WO* 24 hours of store v I w reportn^ recap rasute at wwwxome^encemktg^om and I vn a <npy of this report to QxwagcnceMaritdjng (address

betow). Both the on-ine reap mxirt and ma*sHn copy of tHs report are required fcr payment OnrBne report must be done ** 24 ham of stare vt*Ra^ hart copy nst be pcstnartidwilNn 24 hours of store rtsit

MCSignatures
and Hail in Hard Copy Recap to: Convergence Marketing, Attention; MC

Date: (required)! For Payment, Report Your Hours on Line, Receive Payment Authoriziation #, >61ACocaCofaD 21076