473-P PPI Pricing Form

INFORMATION FOR THE PRODUCER PRICE INDEX
www.bls.gov/ppi
201202 RC:

IC:

NAICS:

OMB NUMBER 1220-0008

1. Instructions: Complete the form and fax to (000) 000-0000 or return to U.S. Department of Labor, Bureau of Labor Statistics,
Code 7, Washington, DC 20212. For assistance, contact IA NAME at IA PHONE or IA EMAIL.

No

Yes

If Yes, please
update below

2. Have the Description, Adjustments to Price, or Terms of Transaction changed?
***Continued on next page****

___
___
___
___
___
___
___
___
___
___
___
___
___
___
Adjustments to Price
Type of Discount

Value/Terms

Type of Surcharge

Value/Terms

Reflected in the
price below?

No

Terms of Transaction
Type of Sale:
Domestic\Foreign Buyer:
Type of Buyer:
Contract Terms:
Size of Shipment:
Unit of Measure:
Freight:

Yes

3. Are there any updates to your Previously Reported Prices?

If yes, please update below.

January 10, 2012

,

,

.

February 14, 2012

,

,

.

March 13, 2012

,

,

.

April 10, 2012

,

,

.

No

4. Has the price changed between April 10, 2012 and May 15, 2012?

$

,

,

.

Yes

If yes, enter the
current price below.

Per:
Type of Price:

cents

5. Please provide reason(s) for significant price changes and/or other remarks.

6. Please review contact information and make corrections in Section 5 above.
NAME
TITLE
ESTABLISHMENT NAME
ADDRESS

Phone:
Fax:
Email:
BLS 473-P

PPI Item Code: