Transcription of Materials Submitted (Check one) Instructions and …
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BRM/QBRM ApplicationFor ZIP+4 Code Assignment/Validation and QBRM ApprovalSee Instructions on Customer information (To Be Completed by the Customer) Company Name / Permit Holder Type of Customer ( check one) Permit Number (Existing customer only) New Customer Existing Customer Address (Street / PO Box) City State ZIP+4 Contact Name Contact Telephone Number Contact E-mail Address information To Be Printed on the Mailpiece: (Print or Type) Rate Category information Company Name Shown on Mailpiece Rate Category Requested ( check one) BRM (Sections 5 and 6 are not applicable.) QBRM (All sections are applicable.) Address (Street / PO Box) Mailpiece information ( check All That Apply Use Inches for Height and Length) City State BRM ZIP+4 (Existing customer only) Postcard (QBRM only): Height
BRM/QBRM Application For ZIP+4 Code Assignment/Validation and QBRM Approval See instructions on reverse. 1. Customer Information (To Be Completed by the Customer)
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