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(908) 498-5140

Email Address

info@boxedmail.com

Office Address

78 Main St, Suite 20, Hackettstown, NJ 07840

Application For Delivery Of Mail

HomeBoxedMail  >  Application Form

Application Form

application form01

    1. Private Mailbox (PMB) Information

    1a. Date PMB Opened

    1b. Date PMB Closed

    2. Commercial Mail Receiving Agency (CMRA) Place of Business Information

    2a. Street Address to be Used for Delivery1

    2b. PMB #

    2c. City

    2d. State

    2e. ZIP+4®

    3. Type of Service Requested*

    Business/Organization Use2

    Residential/Personal Use3

    4. Name of Applicant

    4a. Last Name

    4b. First Name

    4c. Middle Initial

    4d. Telephone Number (include area code)

    4e. Email Address

    4f. Applicant’s Street Home Address 1,4

    4g. City

    4h. State

    4i. ZIP+4

    4j. Country

    4k. Is applicant a court-ordered protected individual? If “Yes,” you must attach a copy of the court order.

    Yes

    No

    5. Authorized Individual5

    5a. Last Name

    5b. First Name

    5c. Middle Initial

    5d. Telephone Number (include area code)

    5e. Email Address

    5f. Authorized Individual’s Street Home Address1,6

    5g. City

    5h. State

    5i. ZIP+4

    5j. Country

    6. If Transferring PMB Mail to Another Address7…

    6a. Street Address Mail Is Transferred To1

    6b. City

    6c. State

    6d. ZIP+4

    6e. Country

    6f. Telephone Number (include area code)

    6g. Email Address

    7. Business/Organization Information

    7a. Name of Business/Organization

    7b. Type of Business

    7c. Business Street Address1

    7d. City

    7e. State

    7f. ZIP+4

    7g. Country

    7h. Telephone Number (include area code)

    7i. Place of Registration8

    8. ID Information for Applicant9

    8a. Applicant’s Name

    8b. Applicant’s ID Number

    8c. Issuing Entity

    8d. Expiration Date on the ID

    8e. Photo ID type (check one)

    U.S. State/Territory/Tribal Driver’s or Nondriver’s ID Card10

    Uniformed Service ID

    Passport

    Certificate of Naturalization

    U.S. Access Card

    Matricula Consular

    U.S. Permanent Resident Card

    U.S. University ID Card

    NEXUS Card4

    9. Address ID Information for Applicant11

    9a. Applicant’s Name

    9b. Applicant’s Street Home Address14f

    9c. City

    9d. State

    9e. ZIP+4

    9f. Country

    9g. Address ID type (check one) — Must Contain the Address in 9b–9f

    U.S. State/Territory/Tribal Driver’s or Nondriver’s ID Card10

    Current Lease

    Home or Vehicle Insurance Policy

    Mortgage or Deed of Trust

    Vehicle Registration Card

    Voter Card

    10. Photo ID Information for Authorized Individual (if applicable)9

    10a. Authorized Individual’s Name

    10b. Authorized Individual’s ID Number

    10c. Issuing Entity

    10d. Expiration Date on the ID

    10e. Photo ID type (check one)

    U.S. State/Territory/Tribal Driver’s or Nondriver’s ID Card12

    Uniformed Service ID

    Passport

    Certificate of Naturalization

    U.S. Access Card

    Matricula Consular

    U.S. Permanent Resident Card

    U.S. University ID Card

    NEXUS Card6

    11. Address ID Information for Authorized Individual (if applicable)11

    11a. Authorized Individual’s Name

    11b. Authorized Individual’s Street Home Address1

    11c. City

    11d. State

    11e. ZIP+4

    11f. Country

    11g. Address ID type (check one) — Must Contain the Address in 11b–11f

    U.S. State/Territory/Tribal Driver’s or Nondriver’s ID Card12

    Current Lease

    Home or Vehicle Insurance Policy

    Mortgage or Deed of Trust

    Vehicle Registration Card

    Voter Card7c

    12. Exceptions for Additional Recipients of Mail13

    13a. Signature of Applicant14

    13b. Date

    14a. Signature of Witness15

    14b. Date