This form cannot be used to close an account or put the account in another name. You must call the office directly for those requests at 1-800-649-6457. Thank you for your cooperation.

All fields marked with an asterik (*) are required:

Customer Information
Name	*
Address:	*
City/Town	*
State	*	Zip*
Phone Number:	*
E-mail
New Information
Please make the following change(s) to my account effective:
Home phone number:
Cell phone number:
Business phone number:
Last name:
Mailing address:
Increase deliveries & reason why:
Alternate contact information:
Email address:
Put the account on will-call:		Yes No
Reason why (if you chose "yes" on the previous question):
Seasonal, please forward mail to this address until (date):