Agent Form Thank you for your interest in becoming an agent for US Monitor. Our agents spend an hour or less every day (except for Sundays and Holidays) processing mail online. It is imperative to our business that the mail is processed every day. In order for you to qualify, you MUST provide the following information. We will contact you if we have an opening in your area. Salutation :    Mr Ms Mrs First Name :      Last Name :      Address 1 :      Address 2 :     (Optional) Apt. No. :    (Optional) City :      State/Province :      Zip/Postal Code :      Country :    Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Arctic Ocean Argentina Armenia Aruba Ashmore and Cartier Islands Atlantic Ocean Australia Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Bassas da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos Islands Colombia Comoros Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Howland Island Hungary Iceland India Indian Ocean Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kerguelen Archipelago Kingman Reef Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Sea Northern Mariana Islands Norway Oman Pacific Ocean Pakistan Palau Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Yugoslavia Zambia Zimbabwe Home Phone :      Daytime Phone :      Cell Phone :    (Optional) Fax :     (Optional) Email :      How long have you been at this residence: Year(s) Month(s)   Do you plan on moving within the next year?   Yes No How many hours a day do you spend on the Internet?   Less than 1 1 - 3 4 - 6 6 or more Would you process US Monitor mail at:     Home Office Both When would you typically do the work for US Monitor?   Morning Afternoon Evening No regular time What is the best way to reach you during normal business hours?      Daytime Phone    Home Phone    Cell Phone    Email Are you able to store 100 pieces of mail or more for one month?     Yes No Do you own and know how to operate a scanner?   Yes No Do you own and know how to operate a digital camera?   Yes No How many weeks a year do you travel for business or vacation?   Week(s)   Do you have someone who can process the mail in your absence?     Yes No If yes, person's name:   Please review your application before submitting.

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