Customer Change Form

    Date Submitted & Year For Enrollment

  • Identification Information

  • Contact Information of person completing this form

  • Request To Change Correspondence/Demographic Information

  • Change Pertains To: (check all that apply)
  • Request To Change Accreditation Agency(ies)

  • Request To Add And/Or Drop Products

  • Score Transmission To Accreditation Agency(ies)

  • All applicable scores will be sent to designated agencies by default unless specified below.
  • Added Products: Indicate Method Of Payment

  • Dropped Products

  • Cancellations and/or adjustments after enrollments and orders have been processed and/or paid will be handled on a case by case basis. All requests must be submitted in writing at least 30 days prior to a scheduled shipment date. The annual processing fee is non–refundable.
  • Dropped Products: Indicate Reason For Drop