PS 4615

PACT Application for Business/Regulatory Purpose Exception (7/2010)

Download and Print the PS 4615

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

Eligibility Number: (USPS entry only - issued by PCSC upon approval of application.)

Business/Regulatory Purposes:

The Prevent All Cigarette Trafficking (PACT) Act provides that cigarettes (including roll-your-own tobacco) and smokeless tobacco may be mailed between federal and state government agencies and/or legally operating businesses that have all applicable state and federal government licenses or permits and are engaged in tobacco product import, export, wholesale, distribution, testing, investigation, research or manufacture.

Such mailings are subject to the conditions of Mailing Standards of the United States Postal Service, Domestic Mail Manual (DMM®), sections 601.11.5.1 to
601.11.5.3.

Section A. Application — Sender Information for Business Entities

Answer the following questions. Please use additional sheets if necessary.

1. All names of or used by organization:

2. Street address(es) of organization:

c. Provide citations to regulations, statutes, or other legal authority under which the entity covered by this application operates.

2a. Mailing address (if different from street address):

PS Form 4615, July 2010 (Page 1 of 2)
a. Name and title:

3. City, State, ZIP Code:

4. Information about agent/employee completing the application:
b. Telephone number (include area code):
c. E-mail address:

5. Applicant

6. Recipient information:

And much more...