Ps Form 5113 - Barcode Certification Customer Application Form - Usps

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Barcode Certification
Customer Application
Certification Program
(Check the applicable certification program)
Delivery Confirmation™
Parcel Barcodes
Signature Confirmation™
Express Mail
Parcel Return Services (PRS)
Special Services
®
Flat Container Label
Sack Container Label
Tray Container Label
International Customs
Customer Information
(Please print)
Company Name
Customer Identification Number (e.g., DUNS
®
number, Mailer ID, etc.)
Contact Name
Street Address, P.O. Box, Rural/Hwy Contract, or Route Number
Apt/Suite
City
State
ZIP + 4
®
Telephone Number (include area code)
Fax Number (include area code)
Email Address
Signature of Contact Person
Date
NOTE: To obtain a unique 9-digit DUNS number, contact Dun & Brandstreet at 1-800-333-0505 or at
Hardware and Software Information
(For Confirmation Services and Special Services ONLY)
Software Name
Version Number
Are you a software Vendor?
In-House Software
Yes
No
Third Party Vendor
Third Party Vendor Information
Indicate the Special Services form/label to be printed and the annual
volume of each.
Vendor Name: _________________________________________
PS Form 3800, Certified Mail Receipt
Volume _________
Contact Name: _________________________________________
PS Form 3804, Return Receipt for Merchandise
Volume _________
PS Form 3813-P, Insured Mail Receipt
Volume _________
Phone Number: ________________________________________
Label 200, Registered Mail
Volume _________
Electronic File Transmission Type
Name of Shipping/Manifest System
Printing System
Internet
Dial-up (modem)
USPS
®
Supplied
No file transmission from ths site
Third Party Software/Hardware
USPS Representative Information
Representative Name
Representative Title
Street Address, P.O. Box, Rural/Hwy Contract, or Route Number
Apt/Suite
City
State
ZIP + 4
Telephone Number (include area code)
Email Address
Application Processing and Contact Information
Mail this completed application to:
Customers needing assistance may call:
BARCODE CERTIFICATION
1-800-238-3150
NATIONAL CUSTOMER SUPPORT CENTER
Monday – Friday
UNITED STATES POSTAL SERVICE
8:00 am - 5:00 pm CST
225 N HUMPHREYS BLVD STE 501
MEMPHIS TN 38188-1001
PS Form 5113,
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January 2013

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