Application for Delivery of Mail Through Agent

Application for Delivery of Mail Through Agent

The Collective Oak Harbor
As required by the United States Postal Service (USPS), Form 1583 must be completed granting our mail center permission to receive your mail. The following questions will populate Form 1583 on your behalf. Proof of identification is required to complete this form and for final approval. An opportunity to upload 2 forms of identification is provided through this form at your convenience.

All applications are subject to review and approval.
1. Date*

MonthDayYear
Date
Address To Be Used for Delivery
3b. City
3c. State
3c. Zip
2. Business or Organization Name *
a. Authorized Delivery Care of Name
d. Address
330 Oak Harbor Blvd, Ste B
c. City
d. State
e. ZIP + 4
Name of Applicant (First Last)*
5. Extended Authorization
N/A
Applicant Home Address (No., street, apt./ste. no)*
City*
State*
ZIP + 4*
Telephone Number (Include area Code)*
Email*
example@example.com
Two types of identification are required. One must contain a photograph of the addressee(s). The other must confirm address of addressee(s) such as an utility bill, voters registration card, etc.

Acceptable identification includes: valid driver's license or state non-driver's identification card; armed forces, government, university, or recognized corporate identification card; passport, alien registration card or certificate of naturalization; current lease, mortgage or Deed of Trust; voter or vehicle registration card; or a home or vehicle insurance policy. A photocopy of your identification may be retained by agent for verification.

Social Security cards, credit cards, and birth certificates are unacceptable as identification. Subject to verification.

Please Upload Copies/Photos OR bring in copies to office location (330 Oak Harbor Blvd, Suite B, Slidell LA ) during normal business hours.
File Upload

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Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature below confirms validity of information provided above. A copy of this form is to retained onsite at The Collective Oak Harbor as well as onsite with the local U.S. Postmaster. The furnishing of false or misleading information on this form or omission of material information may result in criminal sanctions (including fines and imprisonment) and/or civil sanctions (including multiple damages and civil penalties).

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