USPS Form 1583 Intake

Note: Once you complete the form, download + print form to sign and have notarized.
Private Mailbox (PMB) Information
Date PMB Opened
Enter Today's Date
PMB #
Choose one from drop down above
Commercial Mail Receiving Agency (CMRA) Place of Business Information

This section is read only. Please skip to next section 'Type of Service Requested'
Street Address
City
State
ZIP Code
Type of Service Requested
Select one:
Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState (2-letter abbreviation, e.g., NJ)

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Business/Organization Information

Only complete this section if you will receive mail under a business name. If you are using Zenith as your business address, enter: 106 Apple St, 200W-### (your PMB/unit number). If your business is registered at a different address and you are NOT switching it to Zenith, enter that address instead.
Name of Business
Type of Business
Business Address

Street Address

Street Address Line 2

CityState (2-letter abbreviation, e.g., NJ)

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Place of Registration
County, State
Photo ID Information for Applicant

Must be a government-issued photo ID. You will attach a copy of the photo ID in your final submission after notarization.
Photo ID Number
Issuing Entity
(e.g., State of New Jersey – Motor Vehicle Commission, U.S. Department of State)
Expiration Date on the ID

MonthDayYear
Date
Photo ID type (check one)
Address ID Information for Applicant

Address ID must confirm your address listed on this form. You will attach a copy of the address ID in your final submission after notarization.
Applicant's Full Name
First name, Last name
Applicant's Street Home Address

Street Address

Street Address Line 2

CityState (2-letter abbreviation, e.g., NJ)

Zip Code
Address ID type (check one) - Must Contain the Address above
Should be Empty:

Private Mailbox (PMB) Information

Commercial Mail Receiving Agency (CMRA) Place of Business Information

Type of Service Requested

Applicant Information

Business/Organization Information

Photo ID Information for Applicant

Address ID Information for Applicant