UNITED STATES POSTAL SERVICE

REQUEST FOR EXTENSION OR ESTABLISHMENT OF DELIVERY



INSTRUCTIONS TO CUSTOMER(S)


Please complete the following information and return to your local post office which services your area:


Name:              (Last)___________________________ (First)__________________________ (Middle Initial)_____
Street address:  ___________________________________________________________________
City: _________________________________  State:_________________  ZIP Code:__________________________


Is your residence a new construction? _____________  Is it an existing address? ______________
Do you have any neighbors living in your surrounding area? ______________
Do you rent a P.O. box at your local post office? _______________
If yes, what is your P.O. Box address? _______________________________
City: ______________________________ State: ____________ ZIP code: _______________

Please sketch your street location, including your neighboring streets below: