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Renewal Notice for Annual Fee(s)

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					                                                                                                    Renewal Notice for
                                                                                                        Annual Fee(s)
                                     Permit                               Period Due
 Type of Fee                                                Fee                                                  Amount Paid
                                     Number                               (Month/Year-Month/Year)
 Business Reply Mail™
                                                             $185.00                                             $
 Annual Permit Fee
 Business Reply Mail™
                                                             $585.00
 Annual Accounting Fee

 First-Class Mail Presort
                                                             $185.00
 Mailing Fee

 Standard Mail Presort
                                                             $185.00
 Mailing Fee

 Presorted Media Mail
                                                             $185.00
 Mailing Fee
 Presorted Library Mail
                                                             $185.00
 Mailing Fee

 Parcel Select Destinations
 Mailing Fees                                                $185.00
 (BMC, SCF, and/or DU)
 Bound Printed Matter
 Destinations Mailing Fee                                    $185.00
 (BMC, SCF, and/or DU)
 Bulk Parcel Return Service
                                                             $185.00
 Annual Permit Fee
 Bulk Parcel Return Service
                                                             $585.00
 Annual Accounting Fee
 Merchandise Return Service
                                                             $185.00
 Annual Permit Fee
 Merchandise Return Service
                                                             $585.00
 Annual Accounting Fee

                                                                          Total Amount Enclosed $
 Company Name                                                             Customer Name


 Address (Number street, suite, apt., etc.)                               City


 State                               ZIP+4                                Telephone Number (Include area code)


 ❑    Verify that the Permit Number column shows the correct number(s) that applies to your account(s).

 ❑    Enter the full twelve-month period during which you will use the service in the Period Due Column.

 ❑    Enter the fee amount(s) you are paying in the Amount Paid column.

 ❑    Enter the total amount paid.

 ❑    Make your check payable to Postmaster and mail to:
      POSTMASTER




 We appreciate your business. If you have any questions, please call

PS Form 3621-A, May 2009 (7530-02-000-8210)

				
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Description: United States Postal Service Form Form may be out of date. To ensure you have the most up to date form, please visit: http://www.usps.com/forms/allforms.htm