Post Office: Note Mail Arrival Postage …

1 PS Form 3605-R1, January 2018 (Page 1 of 9) PSN 7530-08-000-3305 This form and mailing standards are available on Postal Explorer at States Postal ServicePostage Statement Package Services(Bound Printed Matter, Library Mail, Media Mail) and Parcel Select Use this form for all Package Services. Library Mail and Media Mail may be Office: Note Mail Arrival Date & Time (Do Not Round-Stamp)MailerPermit Holder Name, Address, Email, TelephoneCAPS Cust. Ref. No. CRID Mailing Agent (If other than permit holder) Name, Address, Telephone CRID Mail Owner (If other than permit holder) Name, AddressCRID MailingPost Office of MailingMailer s Mailing Date Federal Agency Cost CodeStatement Seq.

2 No. Hold For Pickup (HFPU)# of pieces No. and type of ContainersSacksFlat TraysPalletsOtherType of PostagePermit ImprintMeteredProcessing Category FlatsIrregular ParcelsParcels/Machinable ParcelsTotal # of Pieces in MailingSSF Transaction#Total Weight Permit #Customer Generated Electronic LabelsDelConSigConFor Barcoded Pieces, Enter Date of Address Matching and Coding / / Packaging Based onPiece CountWeightBothWeight of a Single Piece . poundsCombined Mailing Single ClassMixed ClassPostageParts Completed (Select all that apply): A B C D E S1 Subtotal Postage (Add parts totals)2 Price at Which Postage Affixed (Check one). Correct Lowest NeitherComplete if mailing includes pieces bearing metered/PC Postage .

3 Pcs. x $ . = Postage Affixed-3 Incentive/Discount Flat Dollar Amount-4 Fee Flat Dollar Amount+5 Permit # Net Postage Due (Line 1 +/- Lines 2, 3, 4) usps Use OnlyAdditional Postage Payment (State reason)Add additional payment to net Postage due for affixed or permit imprint choose one only. Total Adjusted Postage AffixedPostmaster: Report Total Postage in AIC 131 (Permit Imprint Only) Total Adjusted BPM Postage Permit ImprintPostmaster: Report Total Postage in AIC 124 (Permit Imprint Only) Total Adjusted Media Mail/Library Mail Postage Permit ImprintPostmaster: Report Total Postage in AIC 211 (Permit Imprint Only) Total Adjusted Parcel Select Postage Permit ImprintCertificationIncentive/Discount Claimed: Type of Fee: The mailer s signature certifies acceptance of liability for and agreement to pay any revenue deficiencies assessed on this mailing, subject to appeal.

4 If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the mailer and that the mailer is bound by the certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or control. The mailer hereby certifies that all information furnished on this form is accurate, truthful, and complete; that the mail and the supporting documentation comply with all postal standards and that the mailing qualifies for the prices and fees claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or misleading information on this form or who omits information requested on this form may be subject to criminal and/or civil penalties, including fines and imprisonment.

5 Privacy Notice: For information regarding our Privacy Policy visit of Mailer or Agent Printed Name of Mailer or Agent Signing FormTelephoneUSPS Use OnlyTo be completed in non-PostalOne! sitesWeight of a Single Piece . poundsTotal WeightAre Postage figures at left adjusted from mailer s entries? Yes No If yes, reason: Round Stamp (Required)Payment DateTotal Pieces Total PostagePresort Verification Performed? (If required) Yes NoI CERTIFY that this mailing has been inspected foreach item below if required:(1) eligibility for Postage prices claimed;(2) proper preparation (and presort where required);(3) proper completion of Postage statement;(4) payment of annual fee; and(5) sufficient funds on deposit (if required)Date Mailer NotifiedContactBy (Initials) Time AM PMUSPS Employee s SignaturePrint usps Employee s NamePackage ServicesPart A Bound Printed Matter PS Form 3605-R, January 2018 (Page 2 of 9)Check box if prices are populated in this section.

6 Part A continued on next pageNonpresorted FlatsZonePriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageA11 & 2A23A34A45A56A67A78A89 Carrier Route FlatsZoneEntryPiece PriceNo. of PiecesPieces SubtotalPound PriceNo. of PoundsPounds Subtotal Subtotal PostageDiscount Total*Fee TotalTotal PostageA91 & 2 NoneA103 NoneA114 NoneA125 NoneA136 NoneA147 NoneA158 NoneA169 NoneA171 & 2 DNDCA183 DNDCA194 DNDCA205 DNDCA21 DSCFA22 DDUC arrier Route Flats with Simplified AddressingZoneEntryPiece PriceNo. of PiecesPieces SubtotalPound PriceNo. of PoundsPounds Subtotal Subtotal PostageDiscount TotalFee TotalTotal PostageA231 & 2 NoneA243 NoneA254 NoneA265 NoneA276 NoneA287 NoneA298 NoneA309 NoneA311 & 2 DNDCA323 DNDCA334 DNDCA345 DNDCA35 DSCFA36 DDU* May contain both Full Service Intelligent Mail and other discount see Instructions page for additional ServicesPart A Bound Printed Matter Continued PS Form 3605-R3, January 2018 (Page 3 of 9) PSN 7530-08-000-3306 Check box if prices are populated in this section.

7 Presorted FlatsZoneEntryPiece PriceNo. of PiecesPieces SubtotalPound PriceNo. of PoundsPounds Subtotal Subtotal PostageDiscount Total*Fee TotalTotal PostageA371 & 2 NoneA383 NoneA394 NoneA405 NoneA416 NoneA427 NoneA438 NoneA449 NoneA451 & 2 DNDCA463 DNDCA474 DNDCA485 DNDCA49 DSCFA50 DDUA51 Detached Address LabelA52 Detached Marketing Label* May contain both Full Service Intelligent Mail and other discount see Instructions page for additional Flats Total (add lines A1 A52) Part A continued on next pagePackage ServicesPart A Bound Printed Matter Continued PS Form 3605-R, January 2018 (Page 4 of 9)Check box if prices are populated in this section. Nonpresorted ParcelsZonePriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageA541 & 2A553A564A575A586A597A608A619 Carrier Route ParcelsZoneEntryPiece PriceNo.

8 Of PiecesPieces SubtotalPound PriceNo. of PoundsPounds Subtotal Subtotal PostageDiscount TotalFee TotalTotal PostageA621 & 2 NoneA633 NoneA644 NoneA655 NoneA666 NoneA677 NoneA688 NoneA699 NoneA701 & 2 DNDCA713 DNDCA724 DNDCA735 DNDCA74 DSCFA75 DDUP resorted ParcelsZoneEntryPiece PriceNo. of PiecesPieces SubtotalPound PriceNo. of PoundsPounds Subtotal Subtotal PostageDiscount TotalFee TotalTotal PostageA761 & 2 NoneA773 NoneA784 NoneA795 NoneA806 NoneA817 NoneA828 NoneA839 NoneA841 & 2 DNDCA853 DNDCA864 DNDCA875 DNDCA88 DSCFA89 DDUA90 BPM Parcels Total (add lines A54 A89)A91 Part A Total (line A53 or A90)Full Service Intelligent Mail OptionA92 Display Only Flats Number of Pieces that Comply x $ =PS Form 3605-R5, January 2018 (Page 5 of 9) PSN 7530-08-000-3307 Package ServicesPart B Library Mail and Media Mail Library MailPriceNo.

9 Of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageB1 BasicB2 Single PieceB35-DigitMedia MailPriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageB4 BasicB5 Single PieceB65-DigitPart B Total (add lines B1 B6)Check box if prices are populated in this section. Parcel SelectPart C Destination Entry PS Form 3605-R, January 2018 (Page 6 of 9)Parcel SelectZoneEntryMachinable/Nonmachinable/ Oversized/BalloonPriceNo. of PiecesSubtotal PostageDiscount TotalFee TotalTotal PostageC11 & 2 DNDCM achinableC23 DNDCM achinableC34 DNDCM achinableC45 DNDCM achinableC51 & 2 DNDCN onmachinableC63 DNDCN onmachinableC74 DNDCN onmachinableC85 DNDCN onmachinableC9 DSCFM achinable 5-DigitC10 DSCFM achinable 3-DigitC11 DSCFN onmachinable 5-DigitC12 DSCFN onmachinable 3-DigitC13 DDUP arcelsC141 & 2 DNDCO versized C153 DNDCO versizedC164 DNDCO versizedC175 DNDCO versizedC18 DSCFO versizedC19 DDUO versizedC201 & 2 DNDCM achinable BalloonC213 DNDCM achinable BalloonC224 DNDCM achinable BalloonC235 DNDCM achinable BalloonC241 & 2 DNDCN onmachinable BalloonC253 DNDCN onmachinable BalloonC264 DNDCN onmachinable BalloonC275 DNDCN onmachinable BalloonC28 DSCFM achinable Balloon 5-DigitC29 DSCFM achinable Balloon

10 3-DigitC30 DSCFN onmachinable Balloon 5-DigitC31 DSCFN onmachinable Balloon 3-DigitC32 DDUB alloonPart C Total (add lines C1 C32)Check box if prices are populated in this section. Parcel SelectPart D Ground PS Form 3605-R7 January 2018 (Page 7 of 9) PSN 7530-08-000-3308 Check box if prices are populated in this section. Parcel Select GroundZonePriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageD11 & 2D23D34D45D56D67D78D89 Parcel Select Ground OversizedZonePriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageD91 & 2D103D114D125D136D147D158D169 Parcel Select Ground BalloonZonePriceNo. of PiecesSubtotal PostageDiscount TotalFe e TotalTotal PostageD171 & 2D183D194D205D216D227D238D249 Part D Total (add lines D1 D24)Parcel Select Lightweight ParcelsPart E Parcels PS Form 3605-R, January 2018 (Page 8 of 9) Check box if prices are populated in this section.