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Request for Confirmation of Authorization

(or Pending Application) to Mail at

Nonprofit USPS Marketing Mail Prices

Part 1 (For completion by applicant)

ƒ Any organization currently authorized or that has filed an

ƒ The organization name in item 1 must match the name of the authorized

application that is pending authorization to mail at the Nonprofit

organization exactly. The applicant named in item 3 must be an

USPS Marketing Mail prices by the Postal Service

™

may obtain

authorized official of the organization completing this form.

confirmation of authorization or pending application to mail at

ƒ File a separate request for confirmation for each Post Office (not a

Nonprofit USPS Marketing Mail prices for mailings to be entered

station or a branch) outside the PostalOne! system for which your

at a PostOffice

outside the PostalOne!

system.

™

organization wants to mail at Nonprofit USPS Marketing Mail prices.

ƒ Confirmation of authorization to mail at Nonprofit USPS

ƒ Submit the completed request to the postmaster at the Post Office

Marketing Mail prices or application pending to mail at those

outside the PostalOne! system where confirmation of authorization or

prices will be issued only to the organization holding the original

pending application to mail at Nonprofit USPS Marketing Mail prices is

authorization or that has applied for authorization.

needed.

No application fee is required. Please be sure all information is complete. Please type or print legibly.

1.Complete Name of Organization

5. Nonprofit USPS Marketing Mail authorization number or pending

application number.

2. Street Address of Organization (Number, street, apartment or suite

6. Post Office (not station or branch) where mailings will be made and

number, city, state, and ZIP+4 ® )

where confirmation of authorization or application pending authorization

to mail at Nonprofit USPS Marketing Mail prices is requested.

3. Name of Person Making this Request (Must be a responsible official of

the requesting organization.)

7. Estimated date of first mailing at Post Office indicated in item 6.

4. Telephone Number (Include area code)

I certify that the statements made by me are true and complete. I

understand that, if this application is approved, a postage refund for the difference

understand that anyone who furnishes false or misleading information on

between the regular USPS Marketing Mail and Nonprofit USPS Marketing Mail

this form or who omits material information requested on the form may

prices may be made for only those regular USPS Marketing Mail mailings entered

be subject to criminal sanctions (including fines and imprisonment) and/

at the Post Office identified above while this application is pending, provided that

or civil sanctions (including multiple damages and civil penalties). I further

the conditions set forth in Domestic Mail Manual 703.1 and 703.1.9 are met.

8. Signature of Applicant

9. Title

10. Date

Part 2 (For completion by postmaster at Non-PostalOne! Post Office when application filed)

Check here if authorized by telephone and enter the authorization

Be sure that the applicant has completed items 1 to 10 in Part 1.

number issued by the Postal Service.

If the national authorization number is known, the postmaster should

request confirmation by calling the Pricing and Classification Service

2. Signature of Postmaster (Or designated representative)

Center at one of the following numbers:

Eastern, New York Metro, and Northeast Areas

(212) 330-5360

3. Date Application Filed With Post Office (Round stamp)

Cap Metro, Southeast, and Southwest Areas

(212) 330-5361

Great Lakes, Pacific and Western Areas

(212) 330-5362

Retain applications approved by telephone at the Post Office. A copy

of the authorization letter sent to the applicant will be sent to the

postmaster.

Send applications not processed by telephone to:

Pricing and Classification Service Center

PO Box 3623

New York NY 10008-3623

3623,

Privacy Notice: See our privacy policy on ®

PS Form

January 2017 (PSN 7530-02-000-9027)

Ps Form 3623 - Request For Confirmation Of Authorization (Or Pending Application) To Mail At Nonprofit Usps Marketing Mail Prices

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