Ps Form 1111 - Bulk Insured Service (Bis) Application
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1United States Postal Service
Bulk Insured Service (BIS) Application
Company Name
Customer Name
Mailing Address (No., street, ste. no., city, state, ZIP + 4)
Signature and Date
Fax No. (Include area code)
Telephone No. (Include area code)
Account Manager Name
Mailing Address (No., street, ste. no., city, state, ZIP + 4)
Phone Number (Include area code)
Verification and Concurrence
For verification of eligibility to participate in the Bulk Insured Service (BIS) program, applicants must:
Mail insured articles under an approved manifest mailing system.
Mail a minimum o f 10,000 insured articles annually (a total of all insured articles mailed at mulitple locations).
Enter the mail enrty locations from which claims will be submitted. If you need additional space. use the reverse side.)
District
Postmaster
USPS Address
Telephone No. (Include area code)
(Include ZIP + 4)
Fax No. (Include area code)
Signature and Date
Name
Signature and Date
MANAGER AC COUNTS PAYABLE BRANCH
ST LOUIS ACCOUNTING SERVICE CENTER
PO BOX 80145
ST. LOUIS, MO 63180-0145
Insured Numbers
1111,
Forward copies to: (1) RCSC
(2) Bulk Mail Entry
(3) Account Manager
PS Form
November 2001
This form available at:
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Parent category: Life