Ps Form 3600-Pm1 - Postage Statement - Priority Mail - Permit Imprint
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13United States Postal Service
Post Office: Note Mail Arrival
Date & Time (Do Not Round-Stamp)
Postage Statement—Priority Mail—Permit Imprint
Use this form for Priority Mail.
Permit Holder
Mailing Agent
Mail Owner
Name, Address, Email, Telephone
(If other than permit holder)
(If other than permit holder)
Name, Address, Telephone
Name, Address
CAPS Cust. Ref. No.
CRID
CRID
CRID
Post Office of Mailing
Mailer’s Mailing Date
Federal Agency Cost Code
Statement Seq. No.
No. and type of Containers
Sacks
1 ft. Letter Trays
Hold For Pickup (HFPU)
Customer Generated
Total Pieces
SSF Transaction ID#
Electronic Labels
2 ft. Letter Trays
SigCon
No. of pieces
EMM Letter Trays
Total Weight
Permit #
Flat Trays
Pallets
Processing
For Mail Enclosed Within Another Class
Weight of a Single Piece
Other
Category
Marketing Mail
Library Mail
.
Letters
pounds
Media Mail
Bound Printed Matter
Flats
First Class
First-Class Mail
This is a Political Campaign Mailing
Yes
No
Parcels
Package Services
Parcel Select
Parcel Select
Priority Mail
Periodicals
Lightweight
Open and
This is Official Election Mail
Yes
No
Distribute
(PMOD)
Parts Completed (Select all that apply):
A
B
C
D
E
F
S
Commercial Base
Commercial Plus
Total Postage (Add parts totals)
Additional Postage Payment (State reason)
Total Adjusted Postage Permit Imprint
Postmaster: Report Total Postage in AIC 237
Incentive/Discount Claimed:
Type of Fee:
The mailer’s signature certifies acceptance of liability for and agreement to pay any revenue deficiencies assessed on this mailing, subject to appeal. If an agent signs this form,
the agent certifies that he or she is authorized to sign on behalf of the mailer and that the mailer is bound by the certification and agrees to pay any deficiencies. In addition,
agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or control. The mailer hereby certifies that all information furnished on
this form is accurate, truthful, and complete; that the mail and the supporting documentation comply with all postal standards and the mailing qualifies for the prices and fees
claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or misleading information on this
form or who omits information requested on this form may be subject to criminal and/or civil penalties, including fines and imprisonment.
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Signature of Mailer or Agent
Printed Name of Mailer or Agent Signing Form
Telephone
Weight of a Single Piece
Total Weight
Are postage figures at left adjusted from mailer’s
Round Stamp (Required)
Payment Date
.
entries?
Yes
No If yes, reason:
pounds
Total Pieces
Total Postage
Presort Verification Performed? (If required)
Yes
No
I CERTIFY that this mailing has been inspected for
Date Mailer Notified
Contact
each item below if required:
(1) eligibility for postage prices claimed;
(2) proper preparation (and presort where required);
(3) proper completion of postage statement;
By (Initials)
Time
AM
(4) payment of annual fee; and
PM
(5) sufficient funds on deposit (if required)
USPS Employee’s Signature
Print USPS Employee’s Name
PS Form 3600-PM1, January 2018 (Page 1 of 12) PSN 7530-13-000-5565
This form and mailing standards are available on Postal Explorer at .
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