Billing Address and Purchase order # changes

(required fields in bold)

Requester's Name & Title:
Full Company Name:
Phone:
Fax:
Email:
ONE of the following three fields MUST be completed in order to process this form.
File #:
Subscriber # (######-###):
Invoice # (Ex. AA-123456):

Does this change affect all files?
	Yes, this change affects all files. Forward me to Part I.
	No, this change affects only certain files.

If no, please list all affected files: (separate files with a comma i.e., 112233, 112233, etc.)

Part I

Would you like to change your address information?
	Yes, I want to change my address information.
	No, forward me to Part II.

Address Change Information

(All fields must be filled out.)

Old Address:
Old City:
Old State/Province:
Old Postal Code:
Old Country:

New Address:
New City:
New State/Province:
New Postal Code:
New Country:

Did your company move to a new address or is this strictly a new mailing address?
	My company moved to a new address.
	This is strictly a change to the mailing address.

Does this new address affect all mailing?

	Yes
	No

If no, please list files/projects that are affected:

File/Project 1:
File/Project 2:
File/Project 3:
File/Project 4:

Part II

Has your company changed its name?
	Yes, my company has changed its name.
	No, please forward me to Part III.

Has your company changed ownership or simply its name?
	Ownership.
	Simply its name.

Old Company Name:
New Company Name:

Part III

Do you wish to change the contact name on your invoices?
	Yes, I want to change the contact name.
	No, forward me to Part IV.

If Yes:

Old Contact Name:
New Contact Name:

Please provide Phone, Fax and E-mail address of new contact.

New Contact Phone:
New Contact Fax:
New Contact Email:

Does this contact name affect all mailings?
	Yes (Forward me to Part IV)
	No

If no, list files/projects affected:

File/Project 1:
File/Project 2:
File/Project 3:
File/Project 4:

Part IV

Do you want to change the Manufacturer's Representative name (this appears in description area of the invoice)?
	Yes, I want to change the Representative's name..
	No, forward me to Part V.

If yes:

Old Manuf Rep Name:
New Manuf Rep Name:

Please provide Phone, Fax and E-mail address of new contact.

New Manuf Rep Phone:
New Manuf Rep Fax:
New Manuf Rep Email:

Part V

Purchase Order Changes

Do you want to change a purchase order (P.O.) number?
	Yes, I want to change a purchase order (P.O.) number.
	No, forward me to the Comment section.

If yes:

Old P.O. number:
New P.O. number:

Is this a blanket PO for all invoices?
	Yes, this PO covers all invoices. Please forward me to the end of this form.
	No, this PO does not cover all invoices.

What type of invoice is your purchase order number going to cover?

New Work Projects (NW)

	All
	Limited:

Project#:
File#:

Follow-Up Services (FS)

	All
	Limited:

Manufacture subscriber # (9 digit #):

All files for this manufacturer?

	Yes
	No

If No, Please provide file #(s) affected:
	(If this request is extensive, please send a letter to the office that handles your files.)

Label (LM)

	Yes
	No

File Specific?

	Yes
	No

If Yes, please provide file#(s):

Multiple Listing (ML)

	Yes
	No

File Specific?

	Yes
	No

If Yes, please provide file#(s):

Additional comments: