HomeMy WebLinkAboutAgreement_General_10/08/2015 (6) UNI TED STATES
POSTAL SERVICE NCOA PROCESSING ACKNOWLEDGEMENT FORM
The collection of information on this Processing Acknowledgement Form (PAF) is required by the Privacy Act of 1974. The United States Postal Service
(USPS') requires that each NCOA Licensee have a completed NCOA` nk PAF for each of their NCOA`' customers prior to providing the NCOA"
service. The Licensee is also required by the USPS to retain a copy of the completed form for each of its customers and to obtain an updated PAF from
each of its customers at minimum once per year. Any signature upon this PAF shall be considered valid for all purposes and have the same effect whether
it is an ink-signed hardcoEyj2d2ocument orequivalent alternative.
LIST OWNER
I, the undersigned, an authorized representative of:
U-lla of T ef oes +�
Company Name
Sys T i L)A +;
Address
12 ues�r,
City D State ZIP +4
%1- ?lot -OLP 3
Telephone Number NAICS USPS Mailer ID (optional) E -mail Address (optional)
Parent Company Name
Marketing or "DBA" Company Name or Primary Affiliate Company Name Company Website (optional)
( �u-� t D I ) L WIC fflja .k r
Name (Please print) Ttle �
Signature Date
do hereby acknowledge that I have received and reviewed the NCOA`' "k Information Package supplied to me by BCC Software. LLC an
NCOA Li Service Provider. I also understand that the sole purpose of the NCOA Li service, is to provide a mailing list correction service
for lists that will be used for preparation of mailings. Furthermore, I understand that NCOA may not be used to create or maintain new
movers' lists.
LICENSEE
BCC Software LLC
Business Name (Please print)
Data Marketing Services
Name (Please print) Title
Signature Date
800 - 337 -0372 585 - 272 -7778
Telephone Number Fax Number
BROKER/AGENT LIST ADMINISTRATOR (Check applicable box)
Business Name (Please print)
Address City /State /ZIP +4
Name (Please print) Title
Signature Date
Telephone Number NAICS Company Website (optional)
For Licensee Use Only
PAF ID: Broker /Agent ID: List Administrator ID: