Unique Delivery Service, Ltd.

Email Address:
First Name:	Middle:		Last Name:
Address Line 1:
Address Line 2:
City:	State:		Zip Code:
County:
Home Phone:
Cell Phone:
Date Of Birth: (mm/dd/yyyy)	Social Security No.:	Important Notice We are committed to protecting the privacy and security of your personal information, including your Social Security Number (SSN). In accordance with applicable laws and regulations, we collect, use, and disclose SSNs only as required or permitted by law. Purpose of Collection Collecting your SSN is mandatory for one or more of the following purposes: To verify your identity. To comply with federal, state, or local tax reporting requirements. To process financial transactions.

Email Address:

First Name:

Middle:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

County:

Home Phone:

Cell Phone:

Date Of Birth:
(mm/dd/yyyy)

Social Security No.:

Important Notice
We are committed to protecting the privacy and security of your personal information, including your Social Security Number (SSN).
In accordance with applicable laws and regulations, we collect, use, and disclose SSNs only as required or permitted by law.

Purpose of Collection
Collecting your SSN is mandatory for one or more of the following purposes:
To verify your identity.
To comply with federal, state, or local tax reporting requirements.
To process financial transactions.

	Unique Delivery Service, Ltd.
Security Personnel Application (pg. 1 of 2)

Password: