Ps Form 5436 – Fill Out and Use

Mailing List Application—

Mail Transportation Services

In order for us to know the type of service and equipment you are interested in providing, please print or type the information requested below and return the form to the contracting officer at the Distribution Networks Office in the area where you currently reside. Upon receipt of the completed form, your name will be placed on our list of persons and companies interested in submitting bids or proposals to transport mail under contract with the United States Postal Service®.

I. Applicant Information

Last Name or Trade Name

First Name

Middle Name

Attention To:

Mailing Address

Mailer ID

DOT

City

State

ZIP + 4®

-

County

Email

Privacy Notice: Your information will be used to provide you requested products, services, or information. Collection is authorized by 39 USC 401, 403, & 404.

Providing the information is voluntary, but if not provided, we may not process your request. We do not disclose your information without your consent to third parties, except to facilitate the request, to act on your behalf or request, or as legally required. This includes the following limited circumstances: to a congressional office on your behalf; to financial entities regarding financial transaction issues; to a USPS® auditor; to entities, including law enforcement, as required by law or in legal proceedings; and to contractors and other entities aiding us to fulfill the service (service providers).

II.Type of Business Organization (Check applicable items only. “See the Supplying Principles and Practices, section Define Supplier Diversity Objectives for definitions."

PS Form 5436, October 2010 (Page 1 of 2)

III.Type of Equipment (Check applicable items only)

0.	Passenger Car or Station Wagon	4.	Heavy Truck (900 cubic feet and above)	8.	Ship (Ocean transportation)
1.	Pickup Truck/Van (100-250 cubic feet)	5.	Tractor-Trailer	9.	Aircraft (FAR 135)
2.	Light Truck (251-499 cubic feet)	6.	Motive Power (Tractor units only)	10. Aircraft (FAR 121)
3.	Medium Truck (500-899 cubic feet)	7.	Boat

IV. Type of Route/Contract

Please indicate the type of operation you are interested in (as explained below) by checking ONLY the boxes applicable to your operation.

A. CDS Delivery — Routes that provide for delivery and collection of mail from homes and businesses.

Individuals: An individual must be at least 21 years of age and able to work legally in the United States. A partnership is qualified if any partner meets the foregoing qualifications of an individual.

B.Highway — Routes that involve the transport of mail between points designated by the United States Postal Service® and do not include CDS delivery service.

C.Water — Routes that involve the transport of mail over water between points designated by the United States Postal Service.

D.Air — Routes that involve the transport of mail by aircraft between points designated by the United States Postal Service. Air carriers must possess the mandatory FAR certification for the size and type of equipment required.

E.Freight — Non-Mail Service. Covers all items other than mail.

F.One-Way Services — Mail Transport Equipment and other mail as directed by Distribution Network Office.

G.Trailer Services — Leased and assigned to Bulk Mail Centers and Processing Centers for short and long term use based on needs of the Area Distribution Networks offices.

V. Areas of Operation

The following is a list of state codes for specified route types. Please indicate ONLY the areas in which you wish to operate by checking the appropriate box(es).

NOTE: Should any of the information change or you no longer wish to receive advertisements, please notify the contracting officer at your area Distribution Networks Office so they may correct the mailing list accordingly.

PS Form 5436, October 2010 (Page 2 of 2)