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    Address Change/Meter Move Form

    * Required Information
    Choose one:
    New License    Address Change/Name Change
     
    *Post Office Where Metered Mail Will be Deposited:
    *Existing Meter License Number:
    (As it appears on license certificate)
    *Finance Number:
    (As it appears on license certificate)
    *Applicant Business Tax Identification Number, Employer:
    *Existing Meter Serial Number:
     
    A. APPLICANT INFORMATION
    *New Company Name:
    (As it should appear on license certificate after update)
    *Old Company Name:
    (As it appears on license certificate for update)
    *Applicant Telephone Number: (ex: 123-456-7890)
    *Current Email Address:
    *Confirm Current Email Address:
     
    B. CUSTOMER DEMOGRAPHIC INFORMATION
    *New Mailing Address
    Street Address:
    (No., street, suite no. or P.O. box no.)
    City
    		 State
    		 Zip Code
    New Physical Address
    (Only if different from address above)
    Street Address:
    (No., street, suite no. or P.O. box no.)
    City
    		 State
    		 Zip Code
    *Old Mailing Address
    Street Address:
    (No., street, suite no. or P.O. box no.)
    City
    		 State
    		 Zip Code
    Old Physical Address
    (Only if different from address above)
    DO NOT enter a post office box number)
    Street address:
    (No., Street, Suite No.
    City
    		 State
    		 Zip Code
    *Old Applicant FAX Number:
    (ex: 123-456-7890)
    *New Applicant FAX Number:
    (ex: 123-456-7890)
     
    C. BUSINESS PROFILE
    *Company's Primary Business Function:
    *Anticipated Annual Metered Postage:
    (For all meters set or licensed at this licensing post office)
    *Annual Percentage of Metered Mail: (Must total 100%)
     % Letters      % Parcels      % Flats
    *Does Your Business Anticipate Mailing Metered Mail at Discounted Rates? Yes No
    *Does Your Business Have an Authorization to Use Permit Imprints at this or any Other Post Office? Yes No
    *Does Your Business Prepare and/or Mail for Other (Third) Parties? Yes No
    *Does Your Business Currently Hold any Other USPS Meter Licenses at this or any Other Post Office? Yes No
    If YES List License Number and Finance Number of Licensing Post Office:
     
    D. CERTIFICATION
    *Have You or Your Business Ever Had a Meter License Revoked?   Yes   No
    If YES, provide specific details:
    (Including dates and licensing post office.)
    *Telephone Number: (ex: 123-456-7890)
    *Printed Name and Title:
    *Authorization Name and Title:
    Comments/Special Instructions:

    Privacy Act Notice
    PS Form 3601-A, May 1996
    Federal Agency Code/Cost Code (For US official penalty indicia license)

    Corporate Business Agent (If applicable)

    The collection of this information is authorized by 39 USC 401 and 404. This information will be used to administer postage meter activities. As a routine use, the information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding to which the US Postal Service is a party or has an interest; to a government agency in order to obtain information relevant to a Postal Service decision concerning employment, security clearances, contracts, licenses, grants, permits, or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants, or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the Postal Service to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of Postal Service finances; to a labor organization as required by the National Labor Relations Act; and to disclose to any member of the public the identity and address of user and identity of agent. Completion of this form is voluntary; however, if this information is not provided, you may not receive meter services.

    I hereby certify by submitting this form that all information furnished on this form is accurate and truthful.
    *Name of Processing Agent: (first & last name)
    (The Submit button only needs to be pressed once.)