United States Postal Service Application for Delivery of Mail Through Agent




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United States Postal Service



Application for Delivery of Mail Through Agent

1. Date

See Privacy Act Statement on Reverse

In consideration of delivery of my or our (firm) mail to the agent named below, the addressee and agent agree: (1) the addressee or the

agent must not file a change of address order with the Postal Service upon termination of the agency relationship; (2) the transfer of mail to

another address is the responsibility of the addressee and the agent; (3) all mail delivered to the agency under this authorization must be

prepaid with new postage when redeposited in the mails; (4) upon request the agent must provide to the Postal Service all addresses to

which the agency transfers mail; and (5) when any information required on this form changes or becomes obsolete, the addressee(s) must

file a revised application with the Commercial Mail Receiving Agency (CMRA).

NOTE:

The applicant must execute this form in duplicate in the presence of the agent, his or her authorized employee, or a notary public.

The agent provides the original completed signed Form 1583 to the Postal Service and retains a duplicate completed signed copy at the

CMRA business location. The CMRA copy of Form 1583 must at all times be available for examination by the postmaster (or designee) and

the Postal Inspection Service. The addressee and the agent agree to comply with all applicable postal rules and regulations relative to

delivery of mail through an agent. Failure to comply will subject the agency to withholding of mail from delivery until corrective action is taken.

This application may be subject to verification procedures by the Postal Service to confirm that the applicant resides or conducts business at

the home or business address listed in boxes 7 or 10, and that the identification listed in box 8 is valid.

2. Name in Which Applicant's Mail Will Be Received for Delivery to Agent. 3. Address to Be Used for Delivery Including ZIP + 4


(Complete a separate Form 1583 for EACH applicant. Spouses may

complete and sign one Form 1583. Two items of valid identification apply to

each spouse. Include dissimilar information for either spouse in appropriate



box.)

4.Applicant Authorizes Delivery to and in Care of 5.This Authorization Is Extended to Include Restricted Delivery Mail for the

(Name, address, and ZIP Code of agent)

Undersigned(s)

6. Name of Applicant 7. Applicant Home Address

(Number, street, city, state

,

and ZIP Code)

8.Two types of identification are required. One must contain a photograph of

the addressee(s). Social Security cards, credit cards, and birth certificates

are unacceptable as identification. The agent must write in identifying

Telephone Number

( )

information. Subject to verification.

a.

9. Name of Firm or Corporation

b. 10. Business Address

(Number, street, city, state and ZIP Code)

Acceptable identification includes: valid driver's license or state non-driver's

identification card; armed forces, government, university or recognized Telephone Number

( )

corporate identification card; passport or alien registration card or certificate

of naturalization; current lease, mortgage or Deed of Trust; voter or vehicle

11. Kind of Business

registration card; or a home or vehicle insurance policy. A photocopy of your

identification may be retained by agent for verification.

12.If Applicant Is a Firm, Name Each Member Whose Mail Is to Be Delivered.

(All names listed must have verifiable identification. A guardian must list the

names and ages of minors receiving mail at their delivery address.)

13. If a CORPORATION, Give Names and Addresses of Its Officers 14.If Business Name of The Address

(Corporation or Trade Name)

Has Been

Registered, Give Name of County and State, and Date of Registration.

Warning: The furnishing of false or misleading information on this form or omission of material information may result in criminal sanctions (including fines and

imprisonment) and/or civil sanctions (including multiple damages and civil penalties).

(18 U.S.C. 1001)

15. Signature of Agent/Notary Public 16.Signature of Applicant

(If firm or corporation, application must be signed

byofficer. Show title.)

PS Form

1583,

August 2000

(Page 1 of 2)

This form on Internet at www.usps.com




Privacy Act Statement

"Privacy Act Statement: The collection of this information is

authorized by 39 USC 403 and 404. This information will be used

to authorize the delivery of the intended addressee's mail to

another. The Postal Service may disclose this information to an

appropriate government agency, domestic or foreign, for law

enforcement purposes; where pertinent, in a legal proceeding to

which the USPS is a party or has an interest; to a government

agency in order to obtain or provide information relevant to an

agency decision concerning employment, security clearances,

contracts, licenses, grants, permits or other benefits; to a

congressional office at your request; to an expert, consultant, or

other person under contract with the USPS to fulfill an agency

function; to the Federal Records Center for storage; and for the

purpose of identifying an address as an address of an agent to

whom mail is delivered on the behalf of other persons.

Information concerning an individual who has filed an appropriate

protected court order with the postmaster will not be disclosed in

any of the above circumstances except pursuant to the order of a

court of competent jurisdiction. Completion of this form is

voluntary; however, without the information, the mail will be

withheld from delivery to the agent and delivered to the

addressee, or, if the address of the addressee is that of the agent,

returned to the sender."

PS Form

1583,

August 2000

(Page 2 of 2)


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