All applicants must complete Part A, items 1 through 19.
- Title of Publication
Print the title of the publication as it appears on the publication.
- Name of Publisher, Agent (for Foreign publications), or Organization
Print the name of the publisher or publishing company or, for foreign publications, the name of the agent or broker.
- ISSN (If assigned)
Place the ISSN (International Standard Serial Number) here if one is already assigned to the publication by the Library of Congress Serials Data Division. Leave blank if no number has been assigned.
- Frequency of Issue
List the frequency as called for by the statement of frequency. (See the examples under “Basic Criteria” noted previously in this handbook.)
- Number of Issues
List the number of issues published annually as called for by the statement of frequency.
- Annual Subscription Price
Indicate the basic annual subscription price if the publication has one.
- Full Name of Owner
Enter the name of the owner of the publication. This could be one or more individuals, a partnership, or a corporation.
- Location of Known Office of Publication
Enter the physical address of the known office of publication where regular business is conducted and circulation records are kept or made available for review. For Foreign publications, this is the physical address of the mailing agent. Be sure to include the county when completing this item.
- Corporate Stockholders
List the names of all stockholders owning 1 percent or more of stock in the company. Use a separate sheet if needed.
- Financial Interest
Check the appropriate box. If “Yes,” describe the interest in the box to the right of item 10.
- Advertising Interest
Check the appropriate box. If “Yes,” describe the interest in the box to the right of item 11.
- Copies to Advertisers
Check the appropriate box. If “Yes,” state the number of copies and the reasons for this extra distribution in the box to the right of item 12. Each advertiser may receive one proof copy that is counted as a valid subscriber or requester copy.
- Issue Date
List the issue date. You may not file an application for Periodicals mailing privileges for publications not meeting Periodicals requirements. Therefore, the date of issue on which the application is based should be the date of the first issue meeting all Periodicals requirements.
- Total Copies Printed
Print the total number of copies produced from your press run or print order for the issue listed in item 13. If there are multiple runs to complete an issue, indicate the total of all press runs or production orders.
- Contact’s Name
Print the name of the individual responsible for completing this form.
- Contact’s Address
Print the contact person’s business address.
- Contact’s Phone Number
Print the contact person’s business phone number.
- Signature
After the rest of the form is completed, have the publisher or publisher’s representative sign the application after reading the certification statement.
- Date
After the rest of the form is completed, enter the date you sign and submit the application.
Items 20 through 26 must be completed by the postmaster or postmaster’s designee.
- Date of First Mailing
Enter the date of the first mailing made under the deposit arrangements after the application was filed. This coincides with the establishment of the pending account for the publication.
- Amount of Fee Paid
Enter the amount of the fee collected for the application.
- Date Fee Paid
Enter the date the fee was paid.
- Name of Postal Contact
Print your name.
- Signature
Sign your name.
- Date Signed
Print the date the application fee was paid and the application was accepted. Also, round-date the application in this area.
- Post Office Address
Enter the address of the Post Office accepting the application.
- Telephone Number
Enter the telephone number of the Post Office accepting the application.
This completes Part A.
