Acknowledgement By Private Mailbox Service Customers Form printable pdf download

Acknowledgment By

Private Mailbox Service Customers

This acknowledgment is required by Section 17538.5 of the California Business and

Professions Code.

Any person obtaining private mailbox receiving service in the State of California must

read and acknowledge receipt of the following statement, which is to be kept on file at

this Commercial Mail Receiving Agency (CMRA) and will be made available, upon

demand, to the Department of Consumer Affairs or any law enforcement agency

conducting an investigation.

By requesting and obtaining use of a CMRA in the State of California, I acknowledge

that:

1. I am obligated to disclose my actual home address or place of residence on a

United States Postal Service (USPS) Form 1583 or other form as may later be

developed and I further agree that I will provide prompt written notice of this

CMRA of any subsequent change in my home address or place of residence.

2. By signing below, I irrevocably authorize this CMRA to act as my Agent for

service of process to receive any legal documents that may be served upon me.

This authorization shall continue from the date of this agreement until two years

after my mail receiving service has been terminated. I understand that this

CMRA will (A) place a copy of the documents or a notice that the documents

were received into my mailbox or other place where I usually receive my mail,

unless my mail receiving service has been terminated, and (B) send all documents

by first-class mail to my home or other last known address to the CMRA.

3. I further acknowledge that I understand that use of a CMRA for commercial

purposes in the State of California requires the user to comply with all applicable

laws, including Section 17538.5 of the Business and Professions Code and laws

prohibiting unfair competition and false advertising as set forth in Sections 17200

and 17500 of the Business and Professions Code. Violation of these laws may

result in criminal and civil penalties or both. I understand that the USPS Form

1583 (that must be prepared for each CMRA customer) shall be delivered to the

local United States Post Office and a copy of the form must be retained by this

CMRA and made available upon demand to the Department of Consumer Affairs

or any law enforcement agency conducting an investigation.

I hereby agree to accept and abide by the foregoing requirements.

Date: ______________________

Signature _________________________________

Name Printed: _____________________________

Street Address: _____________________________

City:______________State___________Zip______

Acknowledgement By Private Mailbox Service Customers Form