Complete a separate Form 1583 for EACH applicant. Spouses may complete and sign one Form 1583. Two items of valid identification apply to each spouse. Include dissimilar information for either spouse in appropriate box. | |
Box (1): | Date: Month/Day/Year. |
Box (2): | YOUR NAME |
Box (3): | 8345 NW 66TH ST #[YOUR PMB] MIAMI FL 33166 |
Box (4): | USABOX, INC. 8345 NW 66TH ST MIAMI FL 33166 |
Box (5): | Indicate whether or not you want us to accept ”Restricted Delivery Mail” for you.
Restricted delivery means that the sender’s mail is delivered only to a specific person or to someone authorized in writing to receive mail for the addressee. If you write ”Yes” we will be authorized to accept mail sent to you using ”Restricted Delivery” service. If you write ”No” we will not be able to receive this type of mail for you. |
Box (6): | YOUR NAME |
Box (7): | Your address and phone number |
Box (8): | Photocopy two ID documents for each person and send them to us with each form (1 form per person). Write the numbers corresponding to these ID documents in a. and b. Have a notary Public witness your signature(s).
Acceptable identification includes: valid driver’s license or state non-driver’s identification card; armed forces, government, university or recognized corporate identification card; passport or alien registration card or certificate of naturalization; current lease, mortgage or Deed of Trust; voter or vehicle registration card; or a home or vehicle insurance policy. |
Box (9): | Name of Firm or Corporation |
Box (10): | Business Address (Number, street, city, state and ZIP Code) and Telephone Number |
Box (11): | Kind of Business |
Box (12): | If Applicant is a Firm, Name Each Member Whose Mail is to be Delivered. (All names listed must have verifiable identification. A guardian must list the names and ages of minors receiving mail at their delivery address.) |
Box (13): | If a CORPORATION, Give Names and Addresses of its Officers |
Box (14): | If Business Name of The Address (Corporation or Trade Name) Has Been Registered, Give Name of County and State, and Date of Registration. |
Box (15): | Signature of Agent/Notary Public |
Box (16): | Signature. |
Please send the completed form with the copies of two identification documents to:
USABOX, INC.
8345 NW 66 ST
MIAMI FL 33166