Ps Form 1093-C - Application For Post Office Caller Service Page 4

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Application for Post Office Caller Service (reverse)

Use this page to list information that could not be contained on the front of the form due to space constraints. Include the item number that the

information refers to, such as, #10 List of names, or #11 Special Orders, etc.

Privacy Act Statement: Your information will be used to provide Post Office Caller Service. Collection is authorized by 39 U.S.C. 401, 403, and 404. Provid-

ing the information is voluntary, but if not provided, we will be unable to provide this service to you. We do not disclose your information to third parties without

your consent, except to facilitate the transaction, to act on your behalf or request, or as legally required. This includes the following limited circumstances: to

a congressional office on your behalf; to financial entities regarding financial transaction issues; to a U.S. Postal Service auditor; to entities, including law

enforcement, as required by law or in legal proceedings; to contractors and other entities aiding us to fulfill the service (service providers); to process servers;

to domestic government agencies if needed as part of their duties; and to a foreign government agency for violations and alleged violations of law. Informa-

tion concerning an individual boxholder who has filed a protective court order with the postmaster will not be disclosed except pursuant to court order. For more

information on our privacy policies see our privacy link on usps.com®.

1093-C,

PS Form

December 2013 (Page 4 of 4)