PS 3615-A

Application for Picture Permit Imprint (5/2012)

Download and Print the PS 3615-A

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

Pursuant to the Mailing Standards of the United States Postal Service, Domestic Mail Manual (DMM®) 604.5, Permit Imprint (Indicia), the mailer listed below (and the mailer’s respective agents or representatives), the “Applicant”, seeks authorization from the United States Postal Service “Postal Service” to use the picture permit imprint format for the attached commercial images and/or text.

A. Applicant’s Eligibility

Permit Imprint Authorization, PS Form 3615:

Permit Number

Date Permit Issued

Issuing Office

Application Fee Due $_______________

Applicant represents that all applicable standards and requirements for permit imprint mailings, including without limitation those set forth in DMM 604.5, have been met.

B. Acknowledgements, Representations, and Warranties

In the event that the attached proposed commercial color images or text — that is pictorial or graphic image, text, name and/or likeness, trademark, including service mark, logo, slogan, and all other types of trademarks as applicable, and any other intellectual property — the “Proposed Content” is authorized by the Postal Service for use as picture permit imprint indicia, Applicant acknowledges, represents and warrants the following:

1. The Postal Service has sole, complete, and unreviewable discretion to suspend or cancel any picture permit imprint authorization without prior notice and without liability for any claims arising out of such suspension or cancellation by Applicant or any third party.

2. The Postal Service asserts that it has not exercised Title 28 U.S.C. § 1498 with respect to any intellectual property that may be applicable to the production or use of picture permit imprint indicia.

3. The Proposed Content is not provided or endorsed by the Postal Service, and Applicant will not make nor cause to be made any representations which could cause a reasonable person to believe that the Proposed Content is provided or endorsed by the Postal Service.

4. Applicant will not make nor cause to be made: (a) any references to the Proposed Content as “stamps” or as “postage stamps”; or (b) any representations that could cause a reasonable person to believe that the Proposed Content is a postage stamp issued by the Postal Service.

5. Applicant possesses, through license or ownership (to the extent needed), the right to display, distribute, reproduce, and otherwise use the Proposed Content.

6. The Proposed Content was prepared in compliance with the laws of copyright, trademark, name and likeness, and other intellectual property.

7. The Proposed Content will be used only as provided by applicable Postal Service regulations, including without limitation requirements for permit imprint indicia contained in DMM 604.5.

8. Applicant will obtain written approval from the Postal Service at least five (5) business

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