Your task is to create a detail data model based on the posted PO-Box Form.
Application for Post Office Box Service W out al nan-shaded fields, and take this applcation to the Post Office 1. This service Is for (Reqwred selectiony: Business/Organization Use Residentlal/Personal Use 2. Name of Business/Organization Wagp cablel: 3. Name of Person Applying (Last Fist, M incudetI representing a business/organization) 4. Address Number, Street, Suite Verity initials City State 5. Telephone Number (ncde Area Code) 6. Email Address 7, Box Size(s) Required) See page 1 far detals O Size 1 OSize 2 OSize 3 OSize 4 Size 5 8. Applicant must select and enter the ID Number for two items of valld identification listed below. You must present the IDs at a Post Office. One Rem must contain a photograph and one must be traceable to the bearer (prove your physical address). Both must be current. Select one photo ID: Select one non-photo ID: Current lease, mortgage, or deed of trust OVoter or vehicle registration card OHome or vehice insurance policy Non-Photo ID Number: Vald driver's license or state non-driver's ID card D Armed forces, govemment, university, or recognized corporate ID OPassport, atien registration card, or certificate of naturatization Photo ID Number: Verify initials (For Past Oftice Use Only) 9 On the back of this lmn, list the name s of all individuals, including members of a business, who will be receiving mail at this these PO Box number 10. On the back of this form, list the names of the persons or representatives of the business/organization authorlzed to pick up mall addressed to this (these) PO Box numberfs) Optional Automatic Renewal Payment Terms and Agreement y initialing below and estabilishing automatic renewal payments at a Post Office, I hereby authorlze the U.S. Postal Sanice (uSPS to charge my credit card for the amount of my designabad box size per USPS pricing cn the scheduled interval I have selected .8,6or 12 manths). This charge could appear on my credlt card statement as early as the 15th ot the month prlor to the due date. if I prowided my email address,1 understand that I will receive emall notfication at least 10 days priorto payment due notice in my PO Box before the payment due date. 1 understand that I may cancel the aulomatic payment option any time atter the Inial application/payment process ls complete during the business hoors at the Post Office whare my bax is Iccated. if I do not cancel by the 14th of the month prior to the next payment dus date,I understand that the payment nil be charged to my credit card. I undersland that if the payment cannot be transacted due to incorrect or obeolete payment information or the transacton would exceed the credit limit of the account, or the bank or credt card company rejects/returns the payment request my PO Box may be cloeed and any mall recelved after closure would te returned to the sender.M my PO Box Is closed far nonpaymant, I understand that i oould be charged a tate payment fes to reactivate my PO Bax service. If there are any changes to my credit card number, blIng address, or explration date, I agree to notily the Post Office where my box is tocated of these changes I understand that this agreement willremain in effect untl or USPS terminates the PO Box service. The USPS may receive updated credit card account indormaton from the inslitution that issued the card idenified for payment, II decide to cose my PD Bax,I must visit the Post Office where my bax is located during business hours. (See the PO Box refund paticy for Informatton ca refunds) The USPS may terminate my particlpation under this automatic payment agreoment in the event I provide Incorrect, false, or fraudulent account information or if I have any returned payment items. te actual credR card charge. I w. also receive Customer Initials Mumber, Street, Suite City Application Date Biling Address (if different fram address v 4 abow) State ZIP+4 Number of KeysCustomer Eligible for No-Fee Service Issued Yes ONo Signature of Applicant (Same as Mem 3 I certify that all information furnished on this form is accurate, truthful, and complete. I understand that anyone who furnishes false or misleading information on this form or omits information requested on this form may be subject to criminal and/or clvll penaltles, Including fines and imprisonment Post Office Date Stamp
