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PS 17-J

Penalty Mail Printed Stamped Envelope Order (5/2008)

Download and Print the PS 17-J

Request may not be processed if the form is incomplete or illegible.

Enter your agency's three-digit code. Enter a cost code if your agency requires
you to do so. Contact your agency's mail manager to obtain these codes.

1. Agency Code

2. Agency Cost Code

3. Date of Order 4. Return ZIP + 4
Month Date Year
Enter the date of order and ZIP + 4®.
NOTE: The ZIP + 4 must be identical to the ZIP + 4 printed in the return address.

5. Ordering Information

6. Order
Name - Title - Signature
Agency/Department Name
Street Address
City, State, and ZIP + 4
Telephone No. (Include area code)

NOTE: Envelopes are available ONLY in boxes of 500.

Multiply the prices in Column f by the quantities in Column "e" and enter the results in Column g.

And much more...