CPU ACH
CPU Write-In Stamp Order Form
All elds are REQURIED to process your order promptly.
Finance No.: Site ID: SFS Customer ID:
CPU Name:
CPU Contact
Person:
CPU Address:
City: State: ZIP + 4 Code Fax:
Telephone Number: Email:
If requesting Priority Mail Express
®
Service, select payment method below. Exact cost
is determined at time of shipment.
Card #:
________________________________________________ Exp. Date: __________
Signature (REQUIRED): _______________________________________________________________
ACH orders may be emailed to
cpu.orders@usps.gov (send as
attachment).
You may fax your ACH debit order to:
Order Entry Stamp Fulfillment
Services
Fax Number: 816-545-1425
Check here for Priority Mail
Express delivery, selecting
payment method at the left.
The Priority Mail Express
option does not guarantee
your order will be shipped
the same day it is received.
For inquiries, contact Customer Service at 800-782-6724 Monday–Friday between 8:00 AM and 4:30 PM EST or by email: cpu.infor@usps.gov.
Orders will be delivered via Priority Mail
®
with Signature Confirmation
™
service.
If your selection is not available, please indicate if you want us to send you a Forever
®
booklet(s) of stamps as a substitute.
Description and value of stamp
Identify the format of the
stamps you are ordering:
Pane, coil, booklet and
number of stamps available
in the format requested.
If requested
format is not
available,
send
substitute
Price Item # Quantity Total
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
For Priority Mail Express: Charge cost to my ACH account (A separate charge will be made
for this option.)
Discover
VISA
MasterCard
Indicate Type of Card to Be Billed:
American Express
Diners Club
Express Mail Corporate Account (EMCA#) __________________________________________
PS Form 5555-ACH, November 2015 Source Code 81001
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
To place your order with a check or money order, mail this form with your payment to:
Order Entry Stamp Fulfillment Services
8300 NE Underground Drive, Pillar 210
Kansas City, MO 64144-0001
Grand Total
Or subtotal if Express Mail option requested
• Stamps may be pre-ordered no sooner than 10 days prior to issue date.
Each pre-order must be submitted on a separate CPU Write-In Stamp Order Form so that your order is not delayed.
If an item is not in stock, this may delay your order. For large volume orders, please determine availability by contacting Customer
Service at 800-782-6724 prior to placing your order.
The maximum coil size that may be ordered are coils of 100. Coils that are in a 3,000 per coil or 10,000 per coil format are not
available for purchase using PS Form 5555-ACH.
•
•
•
Customer ID will be provided on invoice from rst stamp order. Indicate in box if this is your rst order and ID is not available.
Privacy Notice: Your information will be used to respond to your request. Collection is authorized by 39 USC 401, 403, & 404. Providing this
information is voluntary, but if not provided, we may not process your request. We do not disclose your information, except in the following limited
®
circumstances: to a congressional ofce at your request; to nancial entities regarding credit card and payment issues; to a USPS auditor; to
entities, including law enforcement, as required by law or in legal proceedings; and to contractors and other entities to fulll the service. For more
on USPS privacy policies, see our privacy link on www.usps.com.
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signature
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