1.Date

 

 

United States Postal Service
Application For Delievery of Mail Through Agent
See Privacy Act Statement on Reverse


In consideration of delievery of my or our (firm) mail to the agent named below,the addressee and agent agree:(1)the addressee or agent must not file a changed of address order with the Postal Services upon termination of the Agency relationship;(2) the transfer of mail to another address is the responsibility of the addressee and agent;(3)all mail delievered to the agency under this authorization must be prepaid with new postage when redeposited in the mails;(4) upon requests the agent must provide to the Postal Service all addresses to which the agency transfer mail; and (5)when any information required on this form changes or becomes obsolete, the addressee(s) must file a revised application with the Commercial Mail Receving Agency(CMRA).
NOTE:The applicant must execute this form in duplicate in prescence of the agent,his or her authorized employee or a notary public.The agent provides the original completed signed Form 1583 to the Postal Service and retains a duplicate completed signed copy at CMRA business location. The CMRA copy of the form 1583 must at all times be available for examination by the postmaster(or designee)and the Postal Inspection Service.The addressee and agent agree to comply with all applicable postal rules and regulations relative to delievery of mail through an agent.Failure to comply will subject the agencyto withholding of mail from delievery until corrective action is taken.
This application may be subject to verificationprocedures by the Postal Service to confirm that the applicant resides or conduct business at the home or business address listed in boxes 7 or 10 and that the identification listed in box 8 is valid.


2.Name in which applicants mails will be received
(Complete a separate PS Form 1583 for EACH applicant.Spouses may complete and sign one PS Form 1583. Two items of valid identification apply to each spouse.Include dissimilar information for either spouse in appropriate box.)  
3.Address to be used for delievery Including ZIP +4
  
4.Applicant Authorizes to And in care of

  
5.This authorization is extended to include Restricted delievery mail for the undersigned(s)
  
6. Name of applicant
  
7.Applicant Home Address(Number,Street,City,State and ZIP code
  
  Telephone number
  
8.Two types of identifications are required.one must contain a photgraph of the addresses(s).social security cards,credit cards and birth certificates are unacceptable as identification.The agent must write in identifying information.Subject to verification.
  a.
  b.
9.Name of firm or corporation
  
Acceptable identification inclludes: valid driving license or state non drivers identification card.armed forces ,government university or recognzed corporate identification card. 10.Business Address(Number,Street,City,State and ZIP code)
  
  Telephone number
  
11. Kind of Business
  

12.If applicant is a firm, name each member whose mail is to be delivered.(All names listed must have verifiable identification. A guardian must list the names of minors receiving mail at their delivery address.)  

13. If a CORPORATION, Give Names and Addresses of Its Officers
  
14. If business name (corporation or trade name) has been registered, give name of county and state,and date of registration.
  
Warning: The furnishing of false or misleading information on this form or omission of material information may result in criminal sanctions (including fines and imprisonment) and/or civil sanctions (including multiple damages and civil penalties).
15. Signature of Agent
  
16. Signature of Applicant (If firm or corporation, application must be signed by officer.Show title.)
  
PS Form 1583, August 2000 (Page 1 of 2) (7530-01-000-9365)
This form on Internet at www.usps.com´Ż«