3602 N1 Form – Fill Out and Use This PDF

Permit Holder's Name and Address and

Telephone

Name and Address

Telephone

Name and Address of Mail Owner

Email Address, if Any

of Mailing Agent

(If other than permit holder)

<![endif]>Mailer

USPS Nonprofit Auth. No.

(If other than permit holder)

USPS Nonprofit Auth. No.

CAPS Cust. Ref. No.

CRID

CRID

CRID

Post Office of Mailing

Processing Category

Mailer's Mailing Date

Federal Agency Cost Code

Statement Seq. No.

No. and Type of Containers

Letters

____

Sacks

Flats

Type of

Permit Imprint

Marketing Parcels

SSF Transaction #

Total # of Pieces in Mailing

____

1 ft. Letter Trays

Postage

Precanceled Stamps

Parcels - Machinable

Parcels - Irregular

Weight of a Single Piece

Combined Mailing

____

2 ft. LetterTrays

Total Weight

Metered

CMM

0

Mixed Class

<![endif]>Mailing

Catalogs

__ . __ __ __ __ pounds

Single Class

____

EMM Letter Trays

Permit #

For Mail Enclosed within Another Class

Periodicals

Mailpiece is a product sample.

____

Flat Trays

Bound Printed Matter

Library Mail

Media Mail

% Samples

For Automation Pieces, Enter Date

For Carrier Route Pieces, Enter Date

For Carrier Route Price Pieces, Enter

For Pieces Bearing a Simplified Address Enter

____

Pallets

of Address Matching and Coding

of Address Matching and Coding

Date of Carrier Route Sequencing

Date of Delivery Statistics File or Alternative Method

___ ___ / __ __ / ___ ___ ___ ___

___ ___ / ___ ___ / ___ ___ ___ ___

___ ___ / ___ ___ / ___ ___ ___ ___

___ ___ / ___ ___ / ___ ___ ___ ___

____

Other

Move Update Method:

Ancillary Service Endorsement

NCOALink

ACS

Alternative Method

Multiple

OneCode ACS

n/a Alternative Address Format

This is a Political

Yes

No

This is Official Election Mail

Yes

No

Letter-size or flat mailpiece contains DVD/CD or other disk.

Campaign Mailing

Parts Completed (Select all that apply)

A

B

C

D

E

F

G

H

I

J

L

M

S

NSA

<![endif]>Postage

1

Subtotal Postage (Add Parts Totals)

2

Price at Which Postage Affixed (Check one). Complete if the mailing includes pieces bearing metered/PC Postage or precanceled stamps.

-

Correct

Lowest

Neither

__________ pcs. x $ _________ . _________= Postage Affixed

3

Incentive/Discount Flat Dollar Amount:

-

4

Fee Flat Dollar Amount:

+

5

Permit #________

Net Postage Due (Line 1 +/- Lines 2, 3, 4)

Additional Postage Payment (State reason)

<![endif]>Use

For postage affixed, add additional payment to net postage due;

Total Adjusted Postage

Affixed

for permit imprint add additional payment to total postage.

<![endif]>USPS

Postmaster: Report Total Postage in

AIC 125

Total Adjusted Postage Permit

Imprint

(Permit Imprint Only, Excluding Simplified Addressing (EDDM))

Postmaster: Report Total Postage in

AIC 208

Total Adjusted Postage Simplified Addressing

(EDDM)

(Simplified Addressing (EDDM), Permit Imprint Only)

<![endif]>Certification

Incentive/Discount Claimed: ____________________________

Type of Fee: ____________________________

The mailer's signature certifies that: (1) the mailing complies with DMM 703; (2) the income derived from the sale of any products or services advertised in the mailing is not subject to the

Privacy Notice:

For information regarding our Privacy Policy visit www.usps.com.

Unrelated Business Income Tax (UBIT) and any products and services advertised are substantially related to the nonprofit organization's authorized purpose within the meaning of 39 U.S.C.

3626(j)(1)(d)(ii)(I) and 26 U.S.C. 513(A); (3) the mailing if made by a voting registration official is required or authorized under the National Voter Registration Act of 1993; and (4) it will agree to

pay, subject to appeal, any revenue deficiencies assessed on this mailing. If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the mailer, and that the

mailer is bound by the certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or

control. The mailer hereby certifies that all information furnished on this form is accurate, truthful, and complete; that the mail and supporting documentation comply with all postal standards and

that the mailing qualifies for the prices and fees claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or

misleading information on this form or who omits information requested on this form may be subject to criminal and/or civil penalties, including fines and imprisonment.

Signature of Mailer or Agent

Printed Name of Mailer or Agent Signing Form

Telephone

Letters 3.3 oz. (0.2063 lbs.) or less

Entry

Price Category

Price

No. of Pieces

Subtotal

Discount Total* Fee Total

Total Postage

Postage

A1

None

5-Digit

$0.140

A2

None

3-Digit

0.159

A3

None

AADC

0.159

A4

None

Mixed AADC

0.176

A5

DNDC

5-Digit

0.105

A6

DNDC

3-Digit

0.124

A7

DNDC

AADC

0.124

A8

DNDC

Mixed AADC

0.141

A9

DSCF

5-Digit

0.096

A10

DSCF

3-Digit

0.115

A11

DSCF

AADC

0.115

Price

Piece

Or

No. of

Pieces

Pound

Pounds

Subtotal

Discount

Fee

Total

Entry

Amount

Pounds

Category

Price

Pieces

Subtotal

Price

Subtotal

Postage

Total*

Total

Postage

Affixed

A12

None

5-Digit

$0.140

$0.00

A13

None

3-Digit

0.159

0.00

A14

None

AADC

0.159

0.00

A15

None

Mixed

0.176

0.00

AADC

A16

DNDC

5-Digit

0.105

0.00

A17

DNDC

3-Digit

0.124

0.00

A18

DNDC

AADC

0.124

0.00

A19

DNDC

Mixed

0.141

0.00

AADC

A20

DSCF

5-Digit

0.096

0.00

A21

DSCF

3-Digit

0.115

0.00

A22

DSCF

AADC

0.115

0.00

A24

DISPLAY ONLY

Letters - Number of Pieces that Comply_________ x $0.001 =

(Automation) Letters 3.3 oz. (0.2063 lbs.) or less

Entry

Price Category

Price

No. of Pieces

Subtotal

Discount Total*

Fee Total

Total Postage

Postage

C1

None

Saturation

$0.120

C2

None

High Density Plus

0.130

C3

None

High Density

0.133