Partner Organization Name Change Request Form

Partner business points of contact (BPOCs) should submit this form to request an official name change amendment to their Partner license agreement whenever the company name has (or will be) changed. BPOCs can expect to receive an amendment to their agreement for signature within 5 business days of submitting the form.

Name *:
Email Address *:
Phone Number:
Current Partner Organization Name *:
New Partner organization name *:
Date of Change *:	Now(UTC - 05:00)
Reason for change *:	Briefly explain the reason this change is needed
Supporting files:
Location of new company headquarters:
New Office Address 1:
New Office Address 2:
New Office City:
New Office State/Region:
New Office Postal Code:
Any other changes?:
Other Changes Detail:
Anything else you would like to tell us?:
Affirmation of request *: