2. Enter the customer's name (same line for married couples with the

*** If adding a business, the United States Postal
Service requires a copy of identification for each
business listed on the Postal Consent Form. In
order to accommodate this requirement, please
include a piece of identification including the
business name and address, as listed in Boxes 9 &
10 on your form. A business license or articles of
incorporation is preferred for this purpose, but a
utility bill, a lease or mortgage, or any document
or letter from a recognized governmental or
financial institution will also be accepted.
2. Enter the customer’s name
(same line for married couples
with the same last name) or
business name separated by
1. Enter today’s date
3a-d. Enter the customer’s new
ECM address. You must enter
the ECM number (mailbox
number) on line 3a after the “#”.
[Apt; Ste; Building; No; or PMB
will work as well]
3a – e. Earth Class Mail
9450 SW Gemini Drive #101
Beaverton, OR 97008-7105
5. The customer must sign here if
they wish to authorize ECM to
receive restricted mail. You can
also put “Yes” or “No” if you
6. Name of customer
7a-e. Enter the customer’s
residential address. DO NOT
enter a business address. Print
form and fill out manually for
international addresses. One
piece of ID listed in box 8 must
match this home address
8a-b. List down the two pieces of
ID provided and attached for
applicant listed on line 6. One
with photo ID, one with home
address match (box 7a-d)
12. List any employees or minors
in the customer’s family that will
be receiving mail (or attach
separate sheet); list non-business
legal entities such as living trusts
and estates of deceased parties
13. List names and addresses of
any corporate officers (or attach
separate sheet). Usually the only
officer of the company is the
customer setting up the account
9-11. Business info can be the
same as the home address if no
previous address was used as a
business address. Do not put your
ECM address here. ***
14. The name of the business as
registered with a state, county, or
municipal authority, and the
approximate date of registration.
Leave blank if the business is not
16. The customer signs here.
Married couples sharing the
same form both need to sign here