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PS 1111
Bulk Insured Service (BIS) Application (11/2001)
Download and Print
the PS 1111
Request may not be processed if the form is incomplete or illegible.
Company Name - Customer Name
Mailing Address (No., street, ste. no., city, state, ZIP + 4)
Signature and Date
Fax No. (Include area code)
Telephone No. (Include area code)
Account Manager Name
Phone Number (Include area code)
Mailing Address (No., street, ste. no., city, state, ZIP + 4)
For verification of eligibility to participate in the Bulk Insured Service (BIS) program, applicants must:
Mail insured articles under an approved manifest mailing system.
Mail a minimum of 10,000 insured articles annually (a total of all insured articles mailed at mulitple locations).
Enter the mail entry locations from which claims will be submitted. If you need additional space. use the reverse side.)
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