[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 prices, 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]