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STATE OF OREGON

ELEVATOR NAME & ADDRESS CHANGE FORM

All name and address changes must be submitted in writing. Please provide the following information for any address change or correction.


Equipment Information
Site Business Name
Address
City State: Zip
Contact Name
Contact Email
Contact Phone
Site Number
Equipment ID Number(s)

Billing Information
Business Name
Billing Party Mailing Address
City State: Zip
Contact Name
Contact Email
Contact Phone

Owner Information
Owner Name
Mailing Address
City State: Zip
Email
Phone