Instructions

Completed by Postal Employee:
1. Customer Information: Enter customer name (if applicable), address, suite number, city, state, and ZIP + 4 where pickup is requested. If the ZIP + 4 is not known, enter the ZIP Code.
2. Product Information: Enter the quantity of each product to be picked up and enter the estimated weight in pounds for all products.
3. Payment Method: Indicate method of payment for pickup service. Be sure to include account number where applicable.
Completed by the Customer:
4. Affix Stamps or Meter Strip Here: If applicable. 5. Customer Signature. Completed by Postal Employee:
6. This space is for the signature of the postal employee who picks up the mailpiece( 7. The postal employee enters the date and time and place of the pickup.

NOTE TO POSTAL EMPLOYEE: Provide customer part 2, Customer copy; and return part 1, Finance copy to office for processing.