Form 1583a Application To Act As A Commercial Mail Receiving Agency About Usps printable pdf download

United States Postal Service

Application to Act as a Commercial Mail Receiving Agency

1. Date

TO: POSTMASTER

In registering with the Postal Service to act as an agency to receive delivery of mail of others, the agent agrees to the

following: (1) the Commercial Mail Receiving Agency (CMRA) must have on file a Form 1583, Application for Delivery

of Mail Through Agent, for each addressee or firm receiving mail at the agency; (2) a CMRA must represent its

delivery address as a private mailbox; (3) the CMRA is not authorized to accept Registered Mail from their clients for

mailing, the Post Office is the only acceptable mailing point; (4) the CMRA must be in full compliance with Domestic

Mail Manual (DMM) 508.1.8.1 through 508.1.8.4 and other applicable postal requirements to receive delivery of mail

from the Postal Service; and (5) when any information required on this form changes, the CMRA owner or manager

must file a revised application with the postmaster.

NOTE: The CMRA owner or manager must execute this form in duplicate in the presence of the postmaster or

designee. The CMRA owner or manager retains the signed duplicate copy and signs in this space

to signify receipt and understanding of applicable DMM regulations regarding delivery of mail to a CMRA by the

Postal Service. This application may be subject to verification procedures by the Postal Service to confirm that the

CMRA owner or manager resides at the permanent home address listed below, and that identification presented in

box 10 is valid. Failure to comply with DMM 508.1.8.1 through 508.1.8.4 and all other applicable Postal Service

requirements may subject the agency to withholding of mail until corrective action is taken.

2. Name of Commercial Mail Receiving Agency (CMRA) (Corporation or

3. Name of CMRA Owner/Manager

Trade Name)

4. Street Address of CMRA (Number, street, city, state, and ZIP Code)

5. P.O. Box Address of CMRA (Include city, state, and ZIP Code)

6. CMRA Telephone Number

7. Permanent Home Address of CMRA Owner/Manager (Number, street,

city, state, and ZIP Code)

(

)

8. Home Telephone Number of CMRA Owner/Manager

(

)

9. Agency Manager or Contact (Name and telephone number)

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). (18 U.S.C. 1001)

10. Two types of identification are required. One must contain a

See Privacy Act Statement on Reverse

photograph of the CMRA owner or manager. Social Security cards,

11. Signature of CMRA Owner or Manager and Date

credit cards, and birth certificates are unacceptable as identification.

The postmaster or designee must write in type of identifying

information.

Acceptable identification includes: valid driver's license or state non-

12. Signature of Postmaster or Designee and Date

driver's identification card; armed forces, government, university or

recognized corporate identification card; Passport, alien registration

card or certificate of naturalization; current lease, a mortgage, or Deed

of Trust; voter or vehicle registration card; or a home or vehicle

insurance policy. A photocopy of your identification may be retained

by postmaster or designee for verification.

1583-A,

PS Form

June 2011

This form is on the Internet at

Form 1583a Application To Act As A Commercial Mail Receiving Agency About Usps

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