Accounts Receivable Customer Request Form

200 Piedmont Avenue, Suite 1604 West Tower, Atlanta, GA 30334 Phone (404) 463-1993, Fax (404) 463-5089

Instructions for Completion:

1. Check the appropriate box to indicate type of change.
2. Include customer name and FEI/Employee ID on all requests.
3. Use the ‘Comments’ section for other changes not identified on this form or for additional information.
4. Include name and phone number of person submitting request.
5. If the request is to change the customer name, follow up form submission by faxing ONLY the supporting documentation to (404) 463-5089. Please include a fax cover sheet. Acceptable documentation would be a letter from the customer, copies of the legal name change papers from the Secretary of State’s office, or a new W-9 completed by the customer.

Please select the type of request you require. *

New

Change

To make changes to an existing customer, please complete the following information. *

Name Change	Address Change
Location Change	Other Change

FEI/EMPLOYEE ID: *

Location: *

Customer Name * 🛈

Customer ID

Address 🛈

City *

State *

Zip Code *

Phone Number

Extension

Fax Number

Alternative Name 🛈

Comments:

Please Attached Your W-9 *

Submitted By: *

Date: *

Phone Number: *

Approved By *

Date *

Your Email Address: *

If you have any questions, please call the SAO Customer Service Center at 404.657.3956 or 888.896.7771.