@VAR_INCLUDE_HTML=header.txt_@ @VAR_INCLUDE_HTML=custhdr.txt_@

Below is the current address shown in your customer record.

This will send a request for this info to be updated to your customer record.

 

New Info to Submit

Old Info

Name

@VAR_CUST_NAME_@

Address 1 @VAR_ADD1_@
Address 2 @VAR_ADD2_@

Address 3

@VAR_ADD3_@

City @VAR_CITY_@
State @VAR_ST_@
Zip Code @VAR_ZIP_@
Contact @VAR_CONTACT_@
Phone @VAR_PHONE_@
Fax @VAR_FAX_@
E-Mail
  @VAR_EMAIL_@

@VAR_INCLUDE_HTML=footer.txt_@