FORM 1583 INSTRUCTIONS

You may begin receiving items in your account, however you will not be able to request shipments, scans or discards
until you send your form 1583 and related documents. If you do not expect to receive items in your mailbox that may
come through the US Postal Service youmay. send the form via email. To be able to ship USPS items you will need to
send the original and notarized form via postal mail or courier.
This is a one time requirement.

1) Print and fill the boxes of form 1583 as follows:

• BOX 1: Date (Month / Day / Year)
• BOX 2: Your Name
• BOX 3: 10685-B Hazelhurst Dr. # (your account number)
Houston, TX 77043
• BOX 4: USA2Me
10685-B Hazelhurst Dr.
Houston, TX 77043
• BOX 5: Write “Yes” If you would like us to accept “Restricted Delivery Mail” for you.
Write “No” If you would like us not to accept “Restricted Delivery Mail” for you.
Restricted Delivery Mail is mail that can only be delivered to the addressee or to an
authorized agent. Examples: COD, Certified Mail, etc.
Please note that even if you write “Yes” we may only accept restricted delivery mail
when arranged in advanced by you.
• BOX 6: Your Name
• BOX 7: Your address and phone number.
• BOX 8: Photocopy two (2) ID documents. Send the copies to us along the with the form 1583.
Write the numbers of this documents in a & b.
Acceptable Documents include: valid driver's license or state non-driver's
identification card; armed forces, government, university or recognized corporate
identification card; passport or alien registration card or certificate of naturalization;
current lease, mortgage or Deed of Trust; voter or vehicle registration card; or a home
or vehicle insurance policy.
• BOX 9: Name of Firm or Corporation (Only for business accounts)
• BOX 10: Business address and phone number (Only for business accounts)
• BOX 11: Kind of Business (Only for business accounts)
• BOX 12: Name of authorized business recipients. Each person must submit identifications
(Only for business accounts)
• BOX 13: Name and Address of officers or business owners (Only for business accounts)
• BOX 14: Name of Registration,, Address of registration. Phone of Registration (only for
business accounts)
• BOX 15: Signature and Seal of Notary Public.This is only required if you receive USPS items.
If a Notary is not available, an attorney, bank or government official may sign and seal.
• BOX 16: Your original signature

2) If you expect or intend to receive items thorugh ths US Potstal Service in your inbox then:
Send via mail or courier the form 1583, copies of the identification documents, and copy of both sides of
the credit card on record with USA2me, to:

US A2Me – New Accounts

10685-B Hazelhurst Dr. #1000
H ouston, TX 77043
US A

Pho ne: (281) 361-7200

3) If you do not expect to recive items through the US Postal Service in your inbox then you do not need to
notarize the form. You may sign it and emailwith your documents to customerservice@usa2me.com.
United States Postal Service
Application for Delivery of Mail Through Agent 1. Date
See Privacy Act Statement on Reverse
In consideration of delivery of my or our (firm) mail to the agent named below, the addressee and agent agree: (1) the addressee or the
agent must not file a change of address order with the Postal Service upon termination of the agency relationship; (2) the transfer of mail to
another address is the responsibility of the addressee and the agent; (3) all mail delivered to the agency under this authorization must be
prepaid with new postage when redeposited in the mails; (4) upon request the agent must provide to the Postal Service all addresses to
which the agency transfers mail; and (5) when any information required on this form changes or becomes obsolete, the addressee(s) must
file a revised application with the Commercial Mail Receiving Agency (CMRA).
NOTE: The applicant must execute this form in duplicate in the presence of the agent, his or her authorized employee, or a notary public.
The agent provides the original completed signed Form 1583 to the Postal Service and retains a duplicate completed signed copy at the
CMRA business location. The CMRA copy of Form 1583 must at all times be available for examination by the postmaster (or designee) and
the Postal Inspection Service. The addressee and the agent agree to comply with all applicable postal rules and regulations relative to
delivery of mail through an agent. Failure to comply will subject the agency to withholding of mail from delivery until corrective action is taken.
This application may be subject to verification procedures by the Postal Service to confirm that the applicant resides or conducts business at
the home or business address listed in boxes 7 or 10, and that the identification listed in box 8 is valid.
2. Name in Which Applicant's Mail Will Be Received for Delivery to Agent. 3. Address to Be Used for Delivery Including ZIP + 4
(Complete a separate Form 1583 for EACH applicant. Spouses may
complete and sign one Form 1583. Two items of valid identification apply to
each spouse. Include dissimilar information for either spouse in appropriate
box.)

4. Applicant Authorizes Delivery to and in Care of 5.This Authorization Is Extended to Include Restricted Delivery Mail for the
(Name, address, and ZIP Code of agent) Undersigned(s)

6. Name of Applicant 7. Applicant Home Address (Number, street, city, state, and ZIP Code)

8.Two types of identification are required. One must contain a photograph of

the addressee(s). Social Security cards, credit cards, and birth certificates
are unacceptable as identification. The agent must write in identifying
information. Subject to verification. Telephone Number
a.
9. Name of Firm or Corporation

b. 10. Business Address (Number, street, city, state and ZIP Code)

Acceptable identification includes: valid driver's license or state non-driver's

identification card; armed forces, government, university or recognized Telephone Number
corporate identification card; passport or alien registration card or certificate
of naturalization; current lease, mortgage or Deed of Trust; voter or vehicle
11. Kind of Business
registration card; or a home or vehicle insurance policy. A photocopy of your
identification may be retained by agent for verification.
12. If Applicant Is a Firm, Name Each Member Whose Mail Is to Be Delivered. (All names listed must have verifiable identification. A guardian must list the
names and ages of minors receiving mail at their delivery address.)

13. If a CORPORATION, Give Names and Addresses of Its Officers 14. If Business Name of The Address (Corporation or Trade Name) Has Been
Registered, Give Name of County and State, and Date of Registration.

Warning: The furnishing of false or misleading information on this form or omission of material information may result in crimi nal sanctions (including fines and
imprisonment) and/or civil sanctions (including multiple damages and civil penalties). (18 U.S.C. 1001)
15. Signature of Agent/Notary Public 16. Signature of Applicant (If firm or corporation, application must be signed
by officer. Show title.)

PS Form 1583, August 2000 (Page 1 of 2) This form on Internet at www.usps.com

 Privacy Act Statement

"Privacy Act Statement: The collection of this information is

authorized by 39 USC 403 and 404. This information will be used
to authorize the delivery of the intended addressee's mail to
another. The Postal Service may disclose this information to an
appropriate government agency, domestic or foreign, for law
enforcement purposes; where pertinent, in a legal proceeding to
which the USPS is a party or has an interest; to a government
agency in order to obtain or provide information relevant to an
agency decision concerning employment, security clearances,
contracts, licenses, grants, permits or other benefits; to a
congressional office at your request; to an expert, consultant, or
other person under contract with the USPS to fulfill an agency
function; to the Federal Records Center for storage; and for the
purpose of identifying an address as an address of an agent to
whom mail is delivered on the behalf of other persons.
Information concerning an individual who has filed an appropriate
protected court order with the postmaster will not be disclosed in
any of the above circumstances except pursuant to the order of a
court of competent jurisdiction. Completion of this form is
voluntary; however, without the information, the mail will be
withheld from delivery to the agent and delivered to the
addressee, or, if the address of the addressee is that of the agent,
returned to the sender."

PS Form 1583, August 2000 (Page 2 of 2)