®
[Name]
[Address]
Dear [Name]:
You recently began receiving copies of our "[frequency]" magazine, [name of publication].
We hope you enjoy the magazine and continue to receive it as you have requested. Because our
publication is entitled to Periodicals postage rates, we are required to prove to the Postal Service that
our customers have requested [name of publication] and wish to continue receiving it. The Postal
Service has randomly selected your name from our mailing list to help confirm this information.
To confirm that you did request the publication and that you are receiving it, please check the
appropriate boxes and sign the acknowledgment.
I requested and receive [name of publication]. Request Date_______________
I did not request nor do I receive [name of publication].
I receive the publication but did not request it.
SIGNATURE_____________________________________________ DATE______________
Please respond as soon as possible so that we may continue to provide you with the best possible
delivery and service. Return your response to the Postal Service in the envelope provided. Thank you
for your assistance.
Sincerely,
[Name of Publisher or Designee]