Form Usps 3602 N1 – Fill Out and Use This PDF

Permit Holder Name, Address, Email, Telephone

Mailing Agent (If other than permit holder)

Mail Owner (If other than permit

Name, Address, Telephone

holder) Name, Address

USPS Nonprofit Auth. No.

USPS Nonprofit Auth. No.

CAPS Cust. Ref. No.

CRID

CRID

CRID

Post Office of Mailing

Mailer’s Mailing Date

Federal Agency Cost Code

Statement Seq. No.

For Automation Pieces,

No. & Type

Enter Date of Address

of Containers

Matching and Coding

/

/

Sacks

Type of Postage

Processing Category

Parcels–Machinable

Total # of Pieces

SSF Transaction #

Permit Imprint

Letters

Parcels–Irregular

in Mailing

For Carrier Route Pieces,

1 ft. Letter

Enter Date of Address

Precanceled Stamps

Flats

CMM

Total Weight

Permit #

Matching and Coding

Trays

Metered

Marketing Parcels

Catalogs

/

/

2 ft. Letter

For Carrier Route

For Mail Enclosed

Move Update Method

Weight of a Single Piece

Mailpiece is a

Trays

Alternative Method

Price Pieces, Enter

within Another Class

product sample

Date of Carrier Route

Ancillary Service

Multiple

EMM Letter

Bound Printed Matter

Endorsement

0.

pounds

% Samples

Sequencing

OneCode ACS

/

/

Trays

Library Mail

NCOALink

Periodicals

ACS

n/a Alternative

Letter-size or flat mailpiece contains DVD/CD

For Pieces Bearing

Flat Trays

Address Format

or other disk.

a Simplified Address

Media Mail

Enter Date of Delivery

Pallets

Combined Mailing

This is a Political Campaign Mailing

Yes

No

Statistics File or

Alternative Method

Mixed Class

Single Class

This is Official Election Mail

Yes

No

/

/

Other

Parts Completed (Select all that apply):

A

B

C

D

E

F

G

H

I

J

L

S

NSA

1

Subtotal Postage (Add parts totals)

2

Price at Which Postage Affixed (Check one).

Correct

Lowest

Neither

= Postage Affixed

-

Complete if mailing includes pieces bearing metered/PC Postage or precanceled stamps.

pcs. x $

.

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)

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

Total Adjusted Postage Affixed

for permit imprint, add additional payment to total postage.

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]

Incentive/Discount Claimed:

Type of Fee:

Signature of Owner or Agent

Printed Name of Mailer or Agent Signing Form

Telephone

Weight of a Single Piece

Total Weight

Are postage figures at left adjusted from mailer’s entries?

Round Stamp (Required)

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.

Yes

No If yes, reason:

Payment Date

pounds

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Total Pieces

Total Postage

Presort Verification Performed? (If required)

Yes

No

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I CERTIFY that this mailing has been inspected for

Date Mailer Notified

Contact

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each item below if required:

(1) eligibility for postage prices claimed;

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(5) sufficient funds on deposit (if required)

(2) proper preparation (and presort where required);

By (Initials)

Time

AM

(3) proper completion of postage statement;

(4) payment of annual fee; and

PM

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USPS Employee’s Signature

Print USPS Employee’s Name

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