Customer Change Form

This request applies to the following: *

Add / Drop Product

Update Correspondence or Demographic Information

Update Accreditation Agency Information

Contact Information of person completing this form

Contact Information of person completing this form

Request To Add And/Or Drop Products

Request To Add And/Or Drop Products

Added Products: Payment Information

Added Products: Payment Information

VISA/MC: If you wish to pay by credit card, please wait for your invoice for instructions.

Reason for Drop

All cancellations must be submitted in writing at least 30 days prior to scheduled shipment date. A credit will be applied to your account, if appropriate. The annual processing fee is non-refundable. Refund requests will be handled on a case by case basis by the accounts receivable department.

Request To Update Correspondence/Demographic Information

Request To Update Correspondence/Demographic Information

Change Pertains To (check all that apply)

Billing Information

Shipping Information

Send Reports to Information

Address

Apt, suite, etc.

Country

City

State

Zip code

Request To Update Accreditation Agency(ies)

Request To Update Accreditation Agency(ies)

Score Transmission To Accreditation Agency(ies)

Score Transmission To Accreditation Agency(ies)

Do NOT send the following scores to agencies:

All applicable scores will be sent to designated agencies by default unless specified below.

reCAPTCHA is required.

This step is to verify this form is being completed by a person and not a computer.

Enrollment Information

Identification Information