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Request For Exception To Current/Proposed Delivery Mode ...

Mail Delivery by the Current/Proposed method imposes an extreme physical hardship on the customer named below, (Domestic Mail Manual 508 ). A. CUSTOMER INFORMATIONName of CustomerDelivery Address CityStateZIP Code TelephoneEmailCustomer Signature (required)DateB. CURRENT TYPE OF Delivery (Check one)FFCurbline/Rural Box, Apartment BoxFFNeighborhood Delivery (Cluster Box)FFOther (please describe) _____ _____ C. TYPE OF Delivery REQUESTEDType of Delivery RequestedPhysical Reason for hardship Request (attach additional pages if needed) _____ _____ _____ D.

existence of the source of said hardship for example, enclosures, attachments, photographs, physician’s statement or other suitable documentation. Advanced age, although a consideration, is not within itself a qualifying factor for a hardship exception. Provide any information which would apply to your request.

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