USPS Vacant Address Data

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First and Last Name of User*

Phone of User

Email of User*

Password*

Confirm Password*

Name of Supervisor/Manager*

Email of Supervisor/Manager*

Name of Organization*

Type of Organization*

Non-Profit Organization Type*

Tax ID Number (TIN)/ Employer Identification Number (EIN)*

Organization Website (must include http:// or https://)

Please describe how your organization intends to use the data *

Business Address
User's own place of Business

Business Address1*

Business Address2

Business City*

Business State*

Business Zip*

Corporate Address
User's Institution Address
If this address is same as Business Address, Check here:

Corporate Address1

Corporate Address2

Corporate City

Corporate State

Corporate Zip