Date

Date when the form was signed.

Name of Mail Applicant

Name of the person and/or company that will be receiving mail at the location.

Address to be used for Delivery

Business address where you will be receiving your correspondence.

Applicant authorizes delivery to and in care of

Information of the business place where you will be receiving mail.

(Optional) This authorization is extended to

This is to allow an authorized agent to receive restricted delivery mail.

Name of Applicant

Name of the person and/or company that will be receiving mail at the location.

Home Address

Home address of the person that will be receiving mail at the location.

IDs

List of Acceptable IDs (One must contain a picture)

i. Valid Driver’s License or State Non-Driver’s Identification Card

ii. Armed Forces, Government, University or recognized corporate identification card

iii. Passport

iv. Alien Registration Card or Certificate of Naturalization

v. Current Lease, Mortgage, or Deed of Trust

vi. Voter or Vehicle Registration Card

vii. Home or Vehicle Insurance Policy

List of NON Acceptable IDs

i. Social Security Card

ii. Credit Card

iii. Birth Certificate

Company Name

Name of the company that will be receiving mail at the location.

Business Address

The address of the business location where you will be receiving mail or other.

Type of Business

ex. Consulting, Technology, Banking, Financial, etc.

Name of the registered company

Include county, state, and date of

registration of the company.

Operator's Signature

The CMRA agent's signature.

Applicant's Signature

The signature of the person that

corresponds to space (2) in the form.