CHANGE or VERIFY ADDRESS FORM

[Address Change HP] [Address Change ON-LINE] [Verify ON-LINE]

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Name__________________________________ID#(required) ____________

NEW ADDRESS:

Business Name optional)_________________________________________

Address_________________________________________________________

City:___________________________________________________________

State/Prov:________________________ Zip/Postal Code_____________

Country:________________________________________________________

Telephone_______________________________________________________

Fax:____________________________________________________________

email:__________________________________________________________

PREVIOUS ADDRESS:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Mail to:

IFPO-ADDRESS CHANGE/VERIFY
P.O. Box 777, LEWISVILLE NC 27023-0777

FAX to:

336-945-3711


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P.O. Box 42, Hamptonville, NC 27020-0042
phone: 336-468-1138, fax: 336-468-1899