BLQ PAQ Virtual Office

Mailbox Service Application Form

Customers must use the exact mailing address for the mailbox without modification, as outlined in Section 3(3) of Form 1583. The United States Postal Service will return mail without a proper address to the sender, endorsed "Undeliverable as Addressed."

Upon signing the agreement with BLQ PAQ Mailbox Service (The Company), the customer shall provide two (2) forms of valid identification, one of which shall include a photograph.

This agreement may not be amended or modified except in writing, signed by both parties.

A separate P.S. Form 1583 must be completed for each customer. Spouses may complete and sign one P.S. Form 1583. Two items of valid identification apply to each spouse.

The company or agent will provide the original, completed, signed P.S. Form 1583 to the postal service and retain a duplicate, completed, signed copy at the company or agent's business location.

A copy of P.S. Form PS 1583 is always available for examination by the postmaster (or designee) and the Postal Inspection Service.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Company Name*

Industry*

Company Type*

Tell us about the business*

Give a brief Description about your business

How many employees do you have?*

What is your intended lease term?*

12 Months24 Months36 Months

What is your mail forwarding address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Would you like to add an additional mail forwarding address?

YesNo

What is your mail additional forwarding address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mail forwarding options*

Forward Upon RequestForward On Schedule

Forwarding Schedule

WeeklyBi-WeeklyMonthly

Would you like an authorized person to pick up your mail?*

YesNo

Authorized Person Details

	Name	Email	Phone Number
1
2
3

Please upload two forms of ID

N.B. Social Security cards, credit cards, and birth certificates are unacceptable as identification. The agent must write in identifying information. Subject to verification.

Virtual Plans*

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

After making your purchase, it is your obligation to get in touch with BLAQUE Entrepreneur Hub to claim your membership discount. Contact them at investblaque.com. Take note of the membership options provided below. The three memberships listed represent a selection from the four offerings at BLAQUE Entrepreneur Hub. The fourth membership is exclusively available to leaseholders and is already discounted to its lowest price point.

*** Discounts do not apply to annual memberships. ***

Emerging Entrepreneur	Evolving Entrepreneur	Excelling Entrepreneur
$49.99 Monthly	$69.99 Monthly	$89.99 Monthly
Set Up Fee $5.00	Set Up Fee $5.00	Set Up Fee $5.00
10% off Business Consulting Services from AR Consulting, Ste. G1	15% off Business Consulting Services from AR Consulting, Ste. G1	20% off Business Consulting Services from AR Consulting, Ste. G1
Unlimited Access to BLAQUE Lounge	Unlimited Access to BLAQUE Lounge	Unlimited Access to BLAQUE Lounge
2 Daily Guest Passes Per Month	3 Daily Guest Passes Per Month	4 Daily Guest Passes Per Month
1 Day of shared Workstation	2 Days of shared Workstation	1 Day of shared Workstation
------------------------------	------------------------------	1 Day of Private Office Use
2 hours of Creative Space Monthly -1 hour of podcast -1 hour of conference room	3 hours of Creative Space Monthly -2 hours of podcast -1 hour of conference room	4 hours of Creative Space Monthly -3 hours of podcast -1 hour of conference room
20% off Creative Space additional hours	25% off Creative Space additional hours	30% off Creative Space additional hours
10% off printing services	15% off printing services	20% off printing services
Free Access to BLAQUE events	Free Access to BLAQUE events	Free Access to BLAQUE events
20% off Vending at all BLAQUE events	25% off Vending at all BLAQUE events	30% off Vending at all BLAQUE events

For holders of the Executive Office plan, additional details about the EVOVLE CRM can be accessed by clicking the following link: www.evovlesuite.org. To claim your discount, you'll need to provide proof of purchase directly to them.

By signing below, I confirm that I have read the Terms and Conditions carefully and agree with them.

Signature of the Primary Contact Person

Date Signed

Date

BLQ PAQ

Primary Contact Person

Company Details

Virtual Office Details

Customer ID

Payment Details

BLQ PAQ Incorporated