Premium Forwarding Service (Pfs) Application Page 6
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1
2
3
4
5
6Record of PFS Mail Shipments
Employee's
Employee's
Mail Date
Comments
Mail Date
Comments
Initials
Initials
Instructions for completing PFS Application form:
1.
Indicate if this application is for a single individual or the entire household. Check the appropriate box.
2.
Fill-in the last name, first name, and middle initial of PFS applicant.
3.
Provide an email address where PFS applicant can be reached. This information is optional.
4 & 4a. Provide the primary address from where the mail will be reshipped. Follow specific instructions for Puerto Rico.
5 & 5a. Provide the temporary address to where the mail will be shipped. Follow specific instructions for Puerto Rico.
6 - 8.
Provide the city, state, and ZIP+4 of the primary address from where the mail will be reshipped.
9 - 11.
Provide the city, state, and ZIP+4 of the temporary address to where the mail will be reshipped.
12.
Provide a telephone number where the customer can be reached at the primary address. Telephone number can be a land line or
cell phone.
13.
Provide a telephone number where you can be reached at the temporary address. Telephone number can be a land line or cell
phone and can also be same as primary phone number.
14.
Sign and date the application. Your signature confirms your acceptance of the terms and conditions printed on the reverse of the
customer copy.
15.
Indicate when the service starts. The start date is the first day you want the Postal Service to hold the mail for reshipment
through PFS.
16.
Indicate when the service ends. The end date is the last day you want to receive mail at the temporary address
17.
Provide the date to resume mail delivery. This date must not exceed two weeks past the end date of the service.
18.
For Official Use Only - Postal Service personnel calculates the last shipment date based on the customer’s start and end dates
and enters it here. PFS Priority Mail shipments are mailed on Wednesdays.
19.
For Official Use Only - Postal Service personnel provides the name and address of the office accepting the application.
20.
For Official Use Only - Postal Service personnel writes in the type of identification used to verify the customer’s identity and
primary address match.
21.
For Official Use Only - Postal Service personnel initials here to indicate acceptance of customer application, and verification of the
customer’s identity and address match. Postal Service personnel verifies that payment and enrollment fee have been received.
22.
Customer completes optional enrollment questions on the front of the form. (Answering these questions is optional.)
23.
Customer reads privacy statement.
Distribution: Post Office Copy 1 - Post Office
Customer Copy 2 - Customer
Post Office Copy 3 - Shipping Copy
8176
PS Form
, August 2006 (Copy 3 - Post Office Copy, Reverse)
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