NCOA Form

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The collection of information on this Processing Acknowledgement Form (PAF) is required by the Privacy Act of 1974. The United States Postal Service® (USPS®) requires that each NCOALink Licensee have a completed NCOALink PAF for each of their NCOALink customers prior to providing the NCOALink service. The Licensee is also required by the USPS to retain a copy of the completed form for each of its customers and to obtain an updated PAF from each of its customers at minimum once per year. Any signature upon this PAF shall be considered valid for all purposes and have the same effect whether it is an ink-signed hardcopy document or equivalent alternative.

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LIST OWNER

the undersigned, an authorized representative of
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Company
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Address
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Your Full Name
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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Zip Code
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Telephone
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USPS Mailer ID
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NAICS
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Your E-mail Address
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Parent Company Name
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Marketing or “DBA” Company Name or Primary Affiliate Company Name
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Name
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Signature
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Title
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Select a date
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do hereby acknowledge that I have received and reviewed the NCOALink Information Package supplied to me by BCC Software Inc, an NCOALink Service Provider. I also understand that the sole purpose of the NCOA Link service is to provide a mailing list correction service for lists that will be used for preparation of mailings. Furthermore, I understand that NCOA Link may not be used to create or maintain new movers’ lists.
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LICENSEE

Business Name
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Name
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Telephone Number
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Title
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Fax Number
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Business Name
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Address
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City
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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Zipcode
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Name
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Title
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Date
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Your Phonenumber
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Your E-mail Address
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For Licensee Use Only

PAF ID
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Broker Agent ID
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List Administrator ID
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