Application for Delivery of Mail Through Agent

See Reverse for Instructions, Definitions, Agreement Terms, and the Privacy Act Statement.

1. Private Mailbox (PMB) Information

1a. Date PMB Opened

[field id="date_pmb_opened"]

1b. Date PMB Closed

[field id="date_pmb_closed"]

8. Photo ID Information for Applicant

8a. Applicant's Name

[field id="applicants_name"]

8b. Applicant's ID Number

[field id="applicant_id_number"]