Organization Name

Merchant ID

Your Name

Your Title

Your Email

Your Current Address

Street Address

City, ST, ZIP

Your New Address

Street Address

City, ST, ZIP

Reason for Request

How would you like us to apply the new address?
DBA AddressLegal AddressBothMailing Only

Comments

Please upload one of the follow documents:

  • USPS Processed Envelope showing old and new addresses
  • Utility Bill showing new address
  • Updated legal entity paperwork showing the new address

Mailing Address Only:

  • Updated business card
  • A list of company officers with the address
  • Screenshot of website with the address
  • E-mail from an e-mail address on file listing the new address.