PS Form 6805 - BRM/QBRM Application

BRM/QBRM Application
For ZIP+4 Code Assignment/Validation and QBRM Approval
See instructions on reverse.
1. Customer Information (To Be Completed by the Customer)
Company Name / Permit Holder
Type of Customer (Check one)
Permit Number (Existing customer only)
… New Customer
… Existing Customer
Address (Street / PO Box)
City
Contact Name
State
Contact Telephone Number
Address Information To Be Printed on the Mailpiece: (Print or Type)
Company Name Shown on Mailpiece
ZIP+4®
Contact E-mail
Rate Category Information
Rate Category Requested (Check one)
… BRM (Sections 5 and 6 are not applicable.)
… QBRM™ (All sections are applicable.)
Address (Street / PO Box)
Mailpiece Information (Check All That Apply — Use Inches for Height and Length)
City
… Postcard (QBRM only):
… 1-oz. letter (QBRM only):
… 2-oz. letter (QBRM only):
… Other (BRM only):
State
BRM ZIP+4 (Existing customer only)
Height_________ Length__________
Height_________ Length__________
Height_________ Length__________
Height_________ Length__________
Signature: By signing this form, I hereby affirm that I am not requesting any additional ZIP+4 codes for which I do not intend to distribute QBRM.
Signature of Customer or Mail Service Provider
City of Reply Office Where Submitted
State
ZIP+4
Customer: After completing Section 1, submit this form to the local Post Office™ that issues/holds the permit.
2. Issuing Permit Office Information (To Be Completed by the Post Office That Issues/Holds the Permit)
City
State
Finance Number
Cost Center Code
Permit No. Issued to Customer PostalOne!® Office?
… Yes
… No
Employee Verifying Customer’s Receipt/Fees/Letter Employee’s Title
Date
Fees Paid and Amount (Check and complete all that apply)
… (Ver.) Ann. Permit $_______
… Ann. Acct. Maint. $_______
Employee Completing This Section (Full Name)
Employee’s Signature
… Qtr. High-Vol. $_______
Date
Issuing Post Office: After completing Section 2, forward this form to the local AMS office. After AMS completes and returns the form, send a copy to customer.
3. AMS Information (To Be Completed by USPS Address Management Systems)
Date Received
AMS: Do not accept this form unless Sections 1 and 2 have been completed by the customer and the local Post Office.
AMS representatives must enter the permit number and the media code in the AMS database when validating or
assigning a ZIP+4. Assign multiple ZIP+4s only as needed — do not over-code.
Assigned BRM or QBRM ZIP+4 (Check the box if the address is verified, not newly assigned)
… Postcard:
… 1 oz. letter:
… 2 oz. letter:
… Other:
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Employee Completing This Section (Full Name)
Address Error Corrections or Other Comments
– ___ ___ ___ ___
– ___ ___ ___ ___
– ___ ___ ___ ___
– ___ ___ ___ ___
Employee’s Signature
Date
AMS: After completing Section 3, return this form to the local Post Office that issued the permit. The local Post Office will return it to the customer.
4. Customer Instructions for Obtaining Reply Mail Artwork — a Complimentary Service From the Postal Service
Customers distributing BRM or QBRM mailpieces may obtain complimentary artwork directly from the Postal Service as follows:
1. Wait 48 hours after receiving a permit number and ZIP+4 before using the U.S. Postal Service artwork tool.
2. To create a business account, go to the Business Customer Gateway at https://gateway.usps.com/bcg/login.htm.
3. Use the Gateway account to request a Mailer ID (MID), which is required for obtaining reply mail artwork.
4. Select the link for “Automated Business Reply Mail (ABRM)” to design and print reply mail artwork.
5. Access the ABRM user guide at https://ribbs.usps.gov/index.cfm?page=bmatool.
6. For assistance with the ABRM tool, call the MDA Support Center at 855-593-6093.
PS Form 6805, March 2014 (Page 1 of 2)
This form is available on www.usps.com
5. QBRM Customer Guidelines — Application to Distribute and Receive QBRM Prices (To Be Completed by the Customer)
Materials Submitted (Check one)
Instructions and Information
… Samples with the corresponding
Intelligent Mail® barcode printed
on the pieces.
… Paper mockups or pre-production
samples trimmed to the exact
dimension of the mailpiece with
the corresponding Intelligent Mail
barcode printed on the pieces. Use
the actual paper and ink color for
the background and printing.
For each QBRM requested, complete this form, provide ten Business Reply Mail® (BRM)
mailpieces in one of the two formats noted in the box to the left, and submit this form and the ten
sample mailpieces to the Post Office that issued/holds the permit.
QBRM pieces are cards or other letter-size pieces that are prepared and distributed for return
without prepayment of postage under Mailing Standards of the United States Postal Service,
Domestic Mail Manual (DMM®) 505. The applicant is responsible for paying the QBRM prices
and the additional per-piece fee on all pieces returned under this privilege. The applicant agrees
to prepare pieces in accordance with DMM 201, 505, and 708, and understands that failure to
comply with these requirements may result in an inability to receive QBRM prices. QBRM
postcards and letter-size pieces receive reduced First-Class Mail® postage prices and per-piece
fees. For more information, refer to Notice 123, Price List.
Customer: After completing Section 5, submit this form to the local Post Office that will issue/hold the permit.
6. QBRM Review (To Be Completed by USPS MDA)
Date Received
Mailpiece Approved for QBRM?
Remedy Ticket Number
… Yes
… No
MDA Completing This Section (Full Name)
MDA’s Signature
Date
Dear Customer:
Based on your application, the Postal Service has made the following determination regarding your request for entry into the
Qualified Business Reply Mail (QBRM) program at the __________________________________________________ Post Office:
… Approved for participation in the Qualified Business Reply Mail … Disapproved. The attached sample did not meet the following
DMM requirements:
program.
… DMM 201 Sections: ________________________________
Attached is a sample BRM piece approved for the QBRM First-Class
Mail service reduced price plus the applicable per-piece fee.
… DMM 505 Sections: ________________________________
… DMM 708 Sections: ________________________________
If the QBRM application is disapproved, the MDA uses this space to note comments on unmet DMM requirements and necessary corrective action.
MDA: After completing Section 6, process this form as follows: Send the original to the local Post Office that issued the permit; send one copy
directly to the customer; retain one copy for office records.
Instructions for Completing This Form
For BRM applications, the parties must complete Sections 1, 2, and 3. Sections 5 and 6 are not applicable. (Section 4 is for
informational purposes only.)
For QBRM applications, the parties must complete the entire form — Sections 1, 2, 3, 5, and 6. (Section 4 is for informational
purposes only.)
Section 1: The customer completes Section 1 and submits the form to the local Post Office that issues/holds the permit.
Section 2: The local Post Office completes Section 2 and submits the form to the AMS.
Section 3: The AMS completes Section 3 and returns the form to the local Post Office that issues/holds the permit. The local Post
Office returns the form to the customer.
Section 4: Section 4 provides information on how BRM and QBRM customers can obtain mailpiece artwork at no charge from the
Postal Service. A BRM or QBRM customer may obtain mailpiece artwork from another source, but the artwork must meet
all USPS requirements.
Section 5: The customer completes Section 5 and submits the form and the ten sample BRM mailpieces to the local Post Office that
will issue/hold the permit. The local Post Office forwards the form and the ten samples to the MDA.
Section 6: The MDA completes Section 6 and processes the form as follows: Send the original to the local Post Office that issued
the permit; send one copy directly to the customer; retain one copy for office records.
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PS Form 6805, March 2014 (Page 2 of 2)
This form is available on www.usps.com