Ps Form 3602-R1 - Postage Statement - Usps Marketing Mail printable pdf download

United States Postal Service

Post Office: Note Mail Arrival

Date & Time (Do Not Round-Stamp)

Postage Statement—USPS Marketing Mail

Permit Holder

Mailing Agent

Mail Owner

Name, Address, Email, Telephone

(If other than permit holder)

(If other than permit

Name, Address, Telephone

holder) Name, Address

CAPS Cust. Ref. No.

CRID

Post Office of Mailing

Mailer’s Mailing Date

Federal Agency Cost Code

Statement Seq. No.

No. & Type

For Automation Pieces,

Enter Date of Address

of Containers

Matching and Coding

Type of Postage

Processing Category

Total # of Pieces

SSF Transaction#

Sacks

in Mailing

Permit Imprint

Letters

CMM

For Carrier Route Pieces,

1 ft. Letter

Enter Date of Address

Precanceled Stamps

Flats

Catalogs

Total Weight

Permit #

Trays

Matching and Coding

Metered

Marketing Parcels

2 ft. Letter

For Carrier Route

Mailpiece is a

Trays

For Mail Enclosed

Move Update Method

Weight of a Single Piece

Alternative Method

Price Pieces, Enter

product sample

within Another Class

Ancillary Service

Date of Carrier Route

Multiple

EMM Letter

Bound Printed Matter

Endorsement

Sequencing

pounds

% Samples

Trays

OneCode ACS

Library Mail

NCOA

Link

n/a Alternative

Letter-size or flat mailpiece contains DVD/CD

Periodicals

ACS

Flat Trays

For Pieces Bearing

Address Format

or other disk.

a Simplified Address

Media Mail

Enter Date of Delivery

Pallets

This is a Political Campaign Mailing

Yes

Combined Mailing

Statistics File or

Alternative Method

Mixed Class

Single Class

Other

This is Official Election Mail

Yes

Parts Completed (Select all that apply):

NSA

Subtotal Postage (Add parts totals)

Price at Which Postage Affixed (Check one).

Correct

Lowest

Neither

Postage Affixed -

Complete if mailing includes pieces bearing metered/PC Postage or precanceled stamps.

pcs. x $

Incentive/Discount Flat Dollar Amount -

Fee Flat Dollar Amount +

Net Postage Due (Line 1 + / - Lines 2, 3, 4)

5 Permit #

Additional Postage Payment (State reason)

For postage affixed, add additional payment to net postage due;

Total Adjusted Postage Affixed

for permit imprint, add additional payment to total postage.

Postmaster: Report Total Postage in AIC 130

Total Adjusted Postage Permit Imprint

[Permit Imprint Only, Excluding Simplified Addressing (EDDM)]

Postmaster: Report Total Postage in AIC 208

Total Adjusted Postage Simplified Addressing (EDDM)

[Simplified Addressing (EDDM), Permit Imprint Only]

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 that 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 entries?

Round Stamp (Required)

Payment Date

Yes

No If yes, reason: