U.S.

Postal Inspection Service Mail Fraud Report

Important! The form should be completed IN CAPITAL LETTERS using a BLACK or DARK BLUE ballpoint/fountain pen.
Characters and marks should be similar in the style to the following:

SUBJECT OF COMPLAINT
Company Name

First Name City State

Last Name ZIP + 4® Country

Address

Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code)
− − − − − −

Fax Phone (Include Area Code) Email Address

− −

Website Address

YOUR INFORMATION
First Name Last Name

Address Age Range Veteran Status

 12–17  Yes
City State  18–19  No
 20–29

ZIP + 4 Country  30–39

 40–54
 55–64
Email Address
 65 or older

Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code)
− − − − − −

HOW WERE YOU CONTACTED?

KEEP ANY ORIGINAL DOCUMENTS. WE MAY CONTACT YOU ABOUT THE DOCUMENTS.
Check one of the following:
 U.S. Mail™  Telephone  Internet ISP  Website  Email  Phone App  Other

Explain _______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

On what date were you contacted? If by mail, do you have the envelope it Does the envelope have a permit number?
was mailed in?
/ /  Yes  No Permit Number Permit State

Does the envelope have a postage meter number?  Yes  No

Postage Meter Number Permit City

PS Form 8165, July 2021, (Page 1 of 4) See page 4 for Privacy Act Statement
 HOW DID YOU RESPOND TO THIS OFFER?
Check one of the following:
 U.S. Mail™  Telephone  Internet ISP  Website  Email  Phone App  Other

Explain _______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

To what name and address did you mail your response?

Do you have a tracking number?  Yes  No

Tracking Number

What did you receive? __________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

How did it differ from what you expected? ________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________
How much did the company ask you to pay?

Do you have the item?  Yes  No

How was it delivered?
 U.S. Mail  Private Courier  In Person  Other _________________________________________________________________________

______________________________________________________________________________________________________________________________________________

Have you contacted the company or person about the complaint?  Yes  No
If yes, date of last contact
/ /

If no, why?  Address Unavailable  Addressee Not at Address

 Disconnected Telephone  Unlisted Telephone  Unanswered Telephone
Legitimate businesses appreciate feedback. Check the offer for the delivery time, usually 6-8 weeks; then contact the company. Wait 2 weeks after
contacting them before sending us this form. When a delivery time is not specified, a Federal Trade Commission rule mandates fulfillment within 30 days,
unless you applied for first-time credit with the company.
DID YOU LOSE MONEY?

If yes, how much (in U.S. dollars)? Date of Last Payment

 No  Yes
/ /

How did you pay? (Check one)

 Cash

 Postal Money Order (Provide Postal Money Order Number)

 Money Transfer Service (Provide Transfer Service Name and Number)

Transfer Number

 Pay Pal  Debit Card/Credit Card  Check  Other Money Order  Virtual Currency

 Other (explain) _____________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

PS Form 8165, July 2021, (Page 2 of 4) See page 4 for Privacy Act Statement
 TYPE OF MAIL FRAUD COMPLAINT

Find the general category below that describes your area of concern, and check the specific item. (Check one only.)

Advance Payment  International Fraud

 Credit Card Impostor (e.g., IRS, Social Security, grandchild,
 grandparent)
 Credit Repair, Debt Consolidation

 Loans Investment
 Medical Services  Franchise

 Chain Letter  Gems, Coins, Precious Metals

 Charity Fraud  Securities, Stocks

 Contest, Prize, or Sweepstakes

Lottery (You pay to play)
Education Fraud  Domestic

 Certification  Foreign

 Degree
Medical Quackery
Employment  Medical Cure

 Distributorship, Multilevel Marketing  Sexual Aid

 Overseas Job  Weight Loss

 Postal Service Job

Merchandise or Services
 Secret Shopper
 Failure to Pay
 Work at Home
 Failure to Provide

False Bill or Notice  Internet Auction

 Classified Ad  Misrepresentation of Product or Service

 Collection Agency Notice

Mortgage Fraud
 Directory Solicitation
 Foreclosure Rescue
 Office Supplies
 Mortgage Modification
 Subscription/Periodical
 Reverse Mortgage
 Taxes

Personal
Fiduciary (Perpetrated by person in position of trust, financial
advisor, attorney, etc.)  Dating Service

 Bribery, Kickbacks, Embezzlements  False Divorce Decree

 Estate  Mail Order Bride

 Financial Planning
Real Estate
 Will
 Land Sales
Harassment (Merchandise ordered in your name
 without vour consent.)  Timeshare

 Vacation or Travel
Insurance
 Sexually Oriented Advertisement
 Health Care-Related

 Life Insurance Related  Other ________________________________________

 Property Insurance Related

PS Form 8165, July 2021, (Page 3 of 4) See page 4 for Privacy Act Statement
 ADDITIONAL INFORMATION
Use the space below to provide any other, important information about this complaint:

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

Thank you for completing this form. Mail the form and copies of bills, receipts, advertisements, canceled checks (front and back), or correspondence
related to your report to the address below. Do not mail your original. The U.S. Postal Inspection Service is a federal law enforcement agency, and Postal
Inspectors gather facts and evidence to determine whether a violation has occurred under the Mail Fraud or False Representation Statutes. While we
can’t guarantee you will recover money lost to fraud, your information can help alert Inspectors about new fraud schemes and prevent others from being
victimized. Postal Inspectors base mail fraud investigations on the number, substance, and pattern of complaints received from the public; therefore,
we ask you to keep all original documents relating to your complaint, including the solicitation, any mailing envelopes, and canceled checks. Under our
Consumer Protection Program, Postal Inspectors may contact individuals or businesses on your behalf to request that complaints be resolved. We will
contact you if more information is needed. Postal Inspectors caution that, once you have been targeted in a fraud scheme, your name may be passed
along to other con artists, so beware of future solicitations. If you know of others who believe they were victimized by fraud, we recommend they submit
a Mail Fraud Report. Postal Inspectors suggest that, before completing a business transaction, contact the Chamber of Commerce, Better Business
Bureau, or county or state Office of Consumer Affairs where the firm is located to get information on the company. Visit the Better Business Bureau at
bbb.org, the state National Association of Attorneys General at naag.org, and the Postal Inspection Service at www.uspis.gov for more information on
fraud involving use of the mail. Remember: If a deal sounds too good to be true, it probably is!

Return this form to your postmaster, or mail to:

CRIMINAL INVESTIGATIONS SERVICE CENTER

ATTN: MAIL FRAUD
433 W HARRISON STREET, RM 3255
CHICAGO IL 60699-3255

PRIVACY ACT STATEMENT

Your information will be used to submit a mail fraud report and to support investigations of criminal, civil, or administrative matters. Collection is authorized by 39
U.S.C. 401 and 404; and 18 U.S.C. 3061.
Supplying the information is voluntary, but if not provided, we may not be able to investigate your mail fraud complaint. We do not disclose your information to
third parties without your consent, except to act on your behalf or request, or as legally required. This includes the following limited circumstances: Incident to
legal proceedings that the U.S. Postal Service (USPS®) is a party to or has an interest in litigation; for law enforcement purposes when the USPS becomes aware
of an actual or potential violation of law; to a congressional office in response to an inquiry; to entities or individuals under contract or agreement with USPS to
fulfill a function or provide a product or service; to government agencies and other entities authorized to perform audits; to labor organizations as required by law;
to a federal, state, local, or foreign government agency when necessary in connection with decisions by the requesting agency or USPS; to the Equal Employment
Opportunity Commission when requested in connection with the investigation of a formal complaint; to the Merit Systems Protection Board or Office of Special
Counsel for the purpose of litigation; to the public, news media, trade associations, or organized groups to provide information of interest to the public; to a
federal, state, local or foreign prison, probation, parole, or pardon authority or to any other agency involved with the maintenance, transportation, or release of a
person held in custody; and to a foreign country as authorized by an international treaty, convention, or executive agreement or to the extent necessary to assist
such country in apprehending or returning a fugitive to its jurisdiction. For more information on our privacy policies visit www.usps.com/privacypolicy.

Name and Signature Date

/ /

PS Form 8165, July 2021, (Page 4 of 4)