Customer Information Update
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1. Updated Customer Information-
Organization Name:
________________________________
Customer Number: #___________
Billing Address:
Address: _________________________
City: __________ State: ___ Zip: ____
Shipping Address for Materials:
Address: _________________________
City: __________ State: ___ Zip: ____
Contact Information:
Accounting Contact Name:
________________________________
Phone Number:
________________________________
Email:
________________________________
Additional Contact Name:
________________________________
Phone Number:
________________________________
Email:
________________________________
2. Authorization to Update Customer Information-
By signing my signature below, I am certifying that the above information is true and accurate to the best of my knowledge. I also certify that I am an authorized agent and allowed to execute this customer update form.
_______________________ Date_____
Authorized Signature
________________________________
Print Name and Title
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