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<HTML
<HEAD>
<TITLE>Corporate Benefits Request for Change </TITLE>
</HEAD>
<TABLE border>
<TR><TD><IMG align=bottom SRC="ben-pics/lmclogo.gif"></TD>
<TD valign=middle><font size=+2><B>Benefits Request for Change (RFC)</B></font>
</TD></TR>
</TABLE>
<FORM METHOD="POST"
ACTION="http://depot.vf.mmc.com/cgiaccept/corpben/mailform.pl">
<TABLE><TR><TD>
<H4>System: </H4></TD>
<TD><INPUT TYPE="text" NAME="sysname" SIZE="32" MAXLENGTH="32"></TD>
<TD><H4>Date: </H4></TD>
<TD><INPUT TYPE="text" NAME="date" SIZE="8" MAXLENGTH="8"></TD></TR>
</TABLE>
<TABLE><TR><TD><H4>Title: </H4></TD>
<TD><INPUT TYPE="text" NAME="title" SIZE="40" MAXLENGTH="60"></TD>
<TD><IMG SRC="ben-pics/WORLD.GIF"></TD></TR>
</TABLE>
<HR>
<H3> </H3>
<CENTER>
<TABLE BORDER=1>
<TR>
<TH>Originator Name</TH>
<TD><INPUT TYPE="text" NAME="name" SIZE="40" MAXLENGTH="80"></TD>
</TR>
<TR>
<TH>E-Mail Address</TH>
<TD><INPUT TYPE="text" NAME="email" SIZE="40" MAXLENGTH="80"></TD>
</TR>
<TR>
<TH>Organization</TH>
<TD><INPUT TYPE="text" NAME="organization" SIZE="40"
MAXLENGTH="80"></TD>
</TR>
<TR>
<TH>Phone Number</TH>
<TD><INPUT TYPE="text" NAME="phone" SIZE="20" MAXLENGTH="20"></TD>
</TR>
<TR>
<TH>RFC Category:</TH>
<TD><SELECT NAME="category">
<OPTION SELECTED>H/W (Hardware)
<OPTION>S/W (Software)
<OPTION>Documentation
<OPTION>Facility
</SELECT>
</TD>
</TR>
</TABLE>
</CENTER>
<P><B>Description of Change:</B>
<BLOCKQUOTE>
<TEXTAREA NAME="COMMENTS" ROWS="5" COLS="60"></TEXTAREA>
</BLOCKQUOTE>
<CENTER><P><INPUT TYPE="submit" VALUE="Send your feedback"> <INPUT
TYPE="reset"></P></CENTER>
</FORM>
<CENTER>
<P><IMG SRC="ben-pics/YIN_YANG.GIF"><P>
</CENTER>
</BODY>
</HTML>