mid Town Mailbox Identification Form

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Name

First

Last

Phone

Primary Identification (must have picture)

Two types of identification are required for both the Applicant and, if listed, the Authorized Individual. One ID must be a government-issued photo ID. The second must confirm the Applicant’s or Authorized Individual’s address listed on this form. The acceptable types of photo ID are listed in items 8e and 10e. Attach a copy of the photo and address ID documents.

Upload Photo ID

Click or drag files to this area to upload. You can upload up to 10 files.

Secondary Identification (must include home address)

May not use the same ID for Primary Identification and Address Verification

Upload Address Verification

Click or drag files to this area to upload. You can upload up to 10 files.

Address (physical address must match second ID)

Address Line 1

Address Line 2

City

State

Zip Code

Company Name (if applicable)

Will You Have Someone, Other Than Yourself, Picking Up Mail Addressed to You?

If Yes, You will need to provide photo ID and address verification for them also.

(must Email Upload

Will You be Forwarding Mail to Another Address?

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