United States Postal Service
Bulk Insured Service (BIS) Application
Company Name
Customer Name
Mailing Address
(No.,
street, ste. no.,
city,
state, ZIP + 4)
Signature and Date
Fax N
o.
(Include area code)
Telephone No.
(Include area code)
Account Manager Name Mailing Address
(No., street, ste. no., city, state, ZIP + 4)
Phone Number
(Include area code)
Verification and Concurrence
For verification of eligibility to participate in the Bulk Insured Service (BIS) program, applicants must:
Mail insured articles under an approved manifest mailing system.
Mail a minimum o f 10,000 insured articles annually (a total of all insured articles mailed at mulitple locations).
s niocatoLy rtnail EM
Enter the mail enrty locations from which claims will be submitted. If you need additional space. use the reverse side.)
on itacfiriVe
District Postmaster
USPS Address
(Include ZIP + 4)
Telephone No.
(Include area code)
Fax No.
(Include area code)
Signature and Date
e ncerurConc
Name Signature and Date
MANAGER AC COUNTS PAYABLE BRANCH
ST LOUIS ACCOUNTING SERVICE CENTER
PO BOX 80145
ST. LOUIS, MO 63180-0145
Insured Numbers
PS Form
1111,
November 2001
Forward copies to: (1) RCSC (2) Bulk
Mail Entry (3) Account Manager
This
form available at: www.usps.com
click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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