Ps Form 5111 - Address Information System (Ais) Viewer Order Form
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1Address Information System (AIS) Viewer
Order Form
Customer Information
(Please print)
Contact Name
Company Name
Street Address, PO Box, Rural/Contract Delivery Service Route and Box Number
City
State
ZIP + 4
Code
E-mail Address
®
Telephone Number (Include area code)
Fax Number (include area code)
Billing Information
(if different from Customer Information)
Contact Name
Company Name
Street Address, PO Box, Rural/Contract Delivery Service Route and Box Number
City
State
ZIP + 4
Code
E-mail Address
®
Telephone Number (Include area code)
Fax Number (include area code)
Ordering Instructions
Products available for purchase are the City/State Delivery Type Retrieval, County Name Retrieval, Delivery Statistics Retrieval, and
ZIP + 4 Retrieval. The Address Lookup function is free with the purchase of another product. The Address Lookup function is not
available for individual sale. All products are based on an annual subscription with monthly updates. This software is compatible with
Windows 2000, Windows NT, Windows XP, and Windows 7.
Enter the quantity of each product. Multiply the quantity and the cost then enter the results in the purchase amount:
Product Description
Product ID
Quantity
Cost
Purchase Amount
City/State Delivery Type Retrieval
ACS215R
X
$ 70.00
=
County Name Retrieval
ACN215R
X
$ 70.00
=
Delivery Statistic Retrieval
ADS215R
X
$ 100.00
=
ZIP + 4 Retrieval
AZ4215R
X
$ 70.00
=
Total Amount Due
Address Lookup
Free with the purchase of another product.
Add purchase amounts and enter the total amount due
Payment Options
Indicate the method of payment and mail this completed form and pay-
ment to the address below. Please allow 10 business days for processing.
No refunds will be made on products
Customers needing assistance may contact the Customer Care Department
after download.
at 800-238-3150. Prices subject to change without prior notice. Returned
checks will incur a $30.00 fee.
Payment Method
Make check or money order payable to “United States Postal Service
”
®
ACH Credit
Check
USPS
®
Money Order
Visa
American Express
MasterCard
Mail order form and payment to:
ACCOUNTS RECEIVABLE—AIS VIEWER
Card #
NATIONAL CUSTOMER SUPPORT CENTER
UNITED STATES POSTAL SERVICE
Card expiration date:
/
(MM/YY)
225 N HUMPHREYS BLVD STE 501
MEMPHIS TN 38188-1099
Authorized Personnel (please print)
FAX: 901-681-4409
Do not send credit card information via email!
Signature
The signature above indicates that signee accepts total responsibility governing
the use of this card and agrees to comply with the terms of the issuer.
5111,
Privacy Notice: For information regarding our Privacy Policy, visit
PS Form
January 2018
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