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2. This application is used for mailing address changes, phone number changes, and new manager or contact person changes. There is no charge to upgrade our records and no new Receipt will be issued. A name change such as marriage, divorce, or legal personal name (same person) change can also use this form if the personal name is not the Legal Name of the Business. If it is, a Business Name Transfer form will be used. A copy of the proper documentation must be received before a name will be changed in our records.
4. Business Tax Receipt Number *
5. Business Name*
6. Email*
8. Please use this space to indicate OLD information; the information that you are changing.*
10. Please use this space to indicate the NEW information that you would like changed.*
12. Verification documents
13. Additional documents
15. Signature of Business Owner*
    By typing your name here, you are signing this form electronically. You agree you are submitting this affidavit for processing and is the legal equivalent of your manual signature on this form. You must be the legal business owner or authorized agent which match our registration records. Note: A notarized Letter of Authorization is required for an agent to sign the application or any other correspondence that calls for an agent signature.
16. Date:
    Date:
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field