| Box 1: |
Enter Date: Month / Day / Year |
| Box 2: |
Your Full Legal Name in Which Applicant’s Mail Will Be Received for Delivery to Agent. |
| Box 3: |
Enter your mailing address provided by your mail forwarding service: This will be completed by our office when mailbox number is assigned |
| Box 4: |
Enter the mailing address of your mail forwarding agent: 262 Middlesex St Lowell MA 01852 |
| Box 5: |
Enter ‘Yes’ if you want the agent to accept registered mail for you |
| Box 6: |
Enter your Full Legal name |
| Box 7: |
Enter your current address and your phone number |
| Box 8: |
Enter the number of your 2 types of identification. Make copies of those identifications to send with your form. Example: License, Passport, etc.. |
