AFFILIATION AGREEMENT

PTY___________
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I. Basic Information

Please Print
Name: I.D. or Passport #:

Corporation name (for commercial account) R.U.C. (for commercial account)

Address:

Street or Av.
Neighborhood E-Mail House or Bldg.

Tel. Land Line: Cell Phone:

II. Authorized Users.

Please write the names of the persons authorized to send and receive mail through this
account.

Surname Name I.D. or Passport Phone

If necessary, attach an additional sheet of paper.

III. Account Information.

Type of Account

Plan A Plan B Plan VIP Plan VIP +

 IV. Payment Method.

 All MBE box holders require a valid Credit Card to open account.
 If payment will be done with check or cash we require the deposit of the cost of
one month service; which will be reimbursed at the moment of closing the
account.
 MBE bills are issued at the end of each month and will do the charge to the card
during the first 5 days of the month.
 Payments with check or cash must be done by the 10 th of each month, the latest.

1. Visa MasterCard 2. Number: 3. Cardholder:

4. Expiration Date: 5. Security Code #: 6. Issuer:

V. Closing the account.

In order to close the account the customer will sign a letter indicating the suspension of
the service, the date, and will cover any due balance.

VI. Signature.
I have read and understood all parts of this agreement.

_________________________________ _____/_____/_____
Customer’s Signature Date

VII. This section is to be filled out only by a Mail Boxes Etc. representative.

Código de Cuenta: Suite #: Fecha de Inscrip. POS: Inscripcion Plataf:

Monto de Depósito: Factura: Vendedor: Firma del Gerente: