Mailing List Application—
Mail Transportation Services
In order for us to know the type of service and equipment you are interested in providing, please print or type the
information requested below and return the form to the contracting officer at the Distribution Networks Office in the
area where you currently reside. Upon receipt of the completed form, your name will be placed on our list of persons
and companies interested in submitting bids or proposals to transport mail under contract with the United States
Postal Service
®
.
I. Applicant Information
Last Name or Trade Name
First Name Middle Name
Attention To:
Mailing Address
Mailer ID
DOT
City State
-
ZIP + 4
®
County
Email
-- --
Business Telephone Residence Telephone
Social Security or Tax ID No.
PS Form 5436, October 2010 (Page 1 of 2)
II. Type of Business Organization (Check applicable items only. “See the Supplying Principles and Practices,
section Define Supplier Diversity Objectives for definitions."
Small Business Concern
Woman-Owned Business
Labor Surplus Area Concern
Educational or Other Non-Profit Organization
Minority-Owned Business (Check one if applicable)
Black American
Hispanic American
Native American
Asian-Pacific American
Asian-Indian American
Privacy Notice: Your information will be used to provide you requested products, services, or information. Collection is authorized by
39 USC 401, 403, & 404.
Providing the information is voluntary, but if not provided, we may not process your request. We do not disclose your information
without your consent to third parties, except to facilitate the request, to act on your behalf or request, or as legally required. This
includes the following limited circumstances: to a congressional office on your behalf; to financial entities regarding financial transaction
issues; to a USPS
®
auditor; to entities, including law enforcement, as required by law or in legal proceedings; and to contractors and
other entities aiding us to fulfill the service (service providers).
PS Form 5436, October 2010 (Page 2 of 2)
IV. Type of Route/Contract
V. Areas of Operation
Please indicate the type of operation you are interested in (as explained below) by checking ONLY the boxes applicable to your
operation
.
A. CDS Delivery
B. Highway (trucks)
C. Water
F. One-Way Service
E. Freight G. Trailer Services
D. Air
A. CDS Delivery — Routes that provide for delivery and collection of mail from homes and businesses.
Individuals: An individual must be at least 21 years of age and able to work legally in the United States. A partnership is
qualified if any partner meets the foregoing qualifications of an individual.
B. Highway — Routes that involve the transport of mail between points designated by the United States Postal Service
®
and
do not include CDS delivery service.
C. Water — Routes that involve the transport of mail over water between points designated by the United States Postal
Service.
D. Air — Routes that involve the transport of mail by aircraft between points designated by the United States Postal Service.
Air carriers must possess the mandatory FAR certification for the size and type of equipment required.
E. Freight — Non-Mail Service. Covers all items other than mail.
F. One-Way Services — Mail Transport Equipment and other mail as directed by Distribution Network Office.
G. Trailer Services — Leased and assigned to Bulk Mail Centers and Processing Centers for short and long term use based
on needs of the Area Distribution Networks offices.
The following is a list of state codes for specified route types. Please indicate ONLY the areas in which you wish to operate by
checking the appropriate box(es).
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
PR - Puerto Rico
RI - Rhode Island
III. Type of Equipment (Check applicable items only)
0. Passenger Car or Station Wagon
1. Pickup Truck/Van (100-250 cubic feet)
2. Light Truck (251-499 cubic feet)
3. Medium Truck (500-899 cubic feet)
4. Heavy Truck (900 cubic feet and above)
5. Tractor-Trailer
6. Motive Power (Tractor units only)
7. Boat
10. Aircraft (FAR 121)
9. Aircraft (FAR 135)
8. Ship (Ocean transportation)
FL - Florida
NOTE: Should any of the information change or you no longer wish to receive advertisements, please notify the contracting
officer at your area Distribution Networks Office so they may correct the mailing list accordingly.
WY - Wyoming
WI - Wisconsin
WV - West Virginia
WA - Washington
VA - Virginia
VT - Vermont
UT - Utah
TX - Texas
TN - Tennessee
SD - South Dakota
SC - South Carolina
