PS 8176

Premium Forwarding Service® (PFS®) Application
(1/2011)

Download and Print the PS 8176

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

PLEASE READ CAREFULLY BEFORE YOU COMPLETE THIS FORM.

Instructions for completing this form are printed on the reverse of Copy 3 — Origin Post Office Delivery Unit
(“Copy 3 [card stock]”) of this form.

Press firmly and legibly when completing this form — you are making three copies.

The Terms and Conditions governing this service are printed on the reverse of Copy 2 — Customer.

By providing your signature in item 17, you are indicating that you understand and agree to the terms
of this service agreement.

Submit this application only to the Post Office™ that serves your primary address (including any of its
stations or branches).

Only the Post Office (including any of its stations or branches) that serves your
primary address for this service may accept and process this application.

Shaded items 18–21 are for Official Use Only. Only Postal Service™ personnel may complete these items.

Customer Information

1. Premium Forwarding Service® (PFS®) requested for:

Individual Entire Household

And much more...