CPU Credit Card
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:
This payment method is ONLY available for pre-authorized business partners.
Check type of credit card:
Discover VISA Master Card American Express
Credit Card #: ____
_________________________________________ Exp. Date:_____________
Signature (REQUIRED): _____________________________________________________________________
Name on Credit Card (please print): ________________________________________________
Billing address: Complete this section if the billing address for the credit card is different
than the CPU Address provided above. Incomplete/incorrect information may delay your
order.
Address: ______________________________________________________________________
City/State/ZIP Code: ___________________________________________________________
YES! Please ship my order Priority Mail Express
®
using the credit card number
above.
You may fax your order to:
Order Entry Stamp Fulfillment
Services
Fax Number: 1-816-545-1425
Priority Mail Express Option
If you want Priority Mail Express
delivery service, select Payment
method at the left. The Priority Mail
Express option does not guarantee
your order will be shipped the
same day it is received.
Credit Card (This cost will be
a separate charge to the card
provided.)
Priority Mail Express Corporate
Account:
EMCA Acct #: _________________
Exact cost is determined at time
of shipment.
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 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.
Yes No
Yes No
Yes No
Yes No
Yes No
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Yes No
Restricted version/2015
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 this form.
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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.
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
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PS Form 5555-CC, November 2015 Source Code 81008
click to sign
signature
click to edit
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