PresortXtra Customer Qualification Form CAN:__________________________ Company Name:__________________________________________ Contact Name:____________________________________ Phone #:__________________________ Mail Pick-up Contact:______________________________________ Phone #:___________________________ PB Sales Rep Name/Number:___________________________________ District #:________ Postage Meter Model#:_________________________ Postage Meter Serial #:_______________________________________ Folder or Inserter Ordered with PresortXtra __________________________ Average of 500 Pieces Daily (As measured weekly) OR Minimum of 1,000 pieces per pick-up Weekly Monthly Sporadic (Sporadic must average 3,000 pieces per quarter) (Pieces don’t need to look identical) REQUIREMENTS PLEASE COMPLETE ALL CUSTOMER MAIL INFO AND SIGNATURE SECTION Customer Qualifies Estimated Volumes An Average of 500 Pieces Daily ______________ 1,000 Pieces - per Pick-up Weekly ______________ 1,000 Pieces - per Pick-up Monthly ______________ 1,000 Pieces - per Pick-up Sporadic ______________ (Check All that Apply) Size: Letter (#9,10,11 or 6x9) Weight: 1, 2 or 3 oz. Thickness: <1/4” Finish: Matte Color: White or Light Barcode Zone: Clear If no Envelope: Fold on Bottom – Tabs on top Computer Generated No Handwritten No Bar Code Needed Non-Skew Label Address Visible in Window No International Mail Postage Payment: Metered Proper Postage: 1oz. = .414 2oz =.539 ; 3oz =.664 Inscription: Presort First Class Meter Date: The Next Business Day after pick-up Ad Message: D/S Auth, (if required) Customer Qualifies Size.………………….. Weight….…………….. Thickness.…………..... Finish………………… Color.………………… Clear Barcode Zone..... Mail Ready Time: Close of Business Time: Potential for after hours pick-up: First Pick up Date: Customer Q ualifies Computer Generated………. Address visible in window via Tap Test………… Flexible Mail pick-up window. Discount rate used all day. USPS 1 st Class Delivery Service Standards : 1 - 3 days Please call 1-866-MAIL-PBI for scheduling pickups or program questions. AD 11800 R0908 Mail Frequency, Volumes & Type Envelope Type Address Mail Finishing Mail Pick-Up Sales Representative Signature Sales Representative Title Date Customer Representative Signature* Customer Representative Title Date Mail Type Letters Checks Invoices Statements Advertisements General Mail Others Customer Q ualifies Metered Mail.………………. Advanced Dating………….... Prints Discount Rate..………. Inscription Available.………. Drop Ship Requirement.……. Friday Mail Dated for: Saturday (if available)....... Monday....…….... *By signing, I acknowledge (1) that the estimates for my mail volume listed above are accurate and (2) that I have received a copy of and agree to the PresortXtra Mail Processing Agreement. (Double requirements areas need 1000 Daily average or a min. of 2000 pieces per pickups)