Customer Account Change Notice

Customer Account Change Notice

Customer Name:    Account Number:

Company Name:    Company Contact:

WHEREAS

WHEREAS, the Customer maintains an account with the Company identified above and desires to modify certain account information, preferences, or billing arrangements; and

WHEREAS, the Company is willing to process requested changes upon receipt of this duly completed Customer Account Change Notice and any required documentation, subject to verification, applicable fees, and the terms set forth below; and

WHEREAS, both parties intend for this Notice to constitute the Customer's written authorization to effect the requested account changes consistent with Company policy and applicable law.

CHANGE REQUEST DETAILS

Select the type(s) of change requested:

Billing address
Mailing address
Primary contact information
Payment method
Add/remove authorized user(s)
Account name / ownership change
Contact / notification preferences
Other (describe below)

CONTACT & AUTHORIZED USER CHANGES

PAYMENT & BILLING ADJUSTMENTS

New Payment Method:

Billing Schedule:    Late Fee / Interest:

EFFECTIVE DATE AND IMPLEMENTATION

Requested Effective Date:

The Company will use commercially reasonable efforts to implement approved changes by the effective date but reserves the right to delay implementation pending verification of identity, receipt of required documentation, or processing constraints. The Company will notify the Customer of any anticipated delay.

TERM, TERMINATION AND NOTICE

This Notice becomes effective as of the Effective Date and remains in force until the requested changes are implemented or until superseded by a later written notice. Either party may require additional verification and may refuse to implement changes if required documentation is not provided. Customer must provide written notice to the Company at least days prior to requesting reversal or further change to billing or ownership arrangements.

CONFIDENTIALITY

Both parties acknowledge that account information and related personal data provided pursuant to this Notice constitute confidential business information. Each party agrees to use commercially reasonable safeguards to protect such information and will not disclose it except (a) as required by law or regulation, (b) to its affiliates or contractors on a need-to-know basis for implementation of the changes, or (c) with the disclosing party's prior written consent. Mandatory disclosures required by law shall be promptly disclosed to the other party to the extent permitted.

LIMITATION OF LIABILITY

Except for willful misconduct or gross negligence, neither party will be liable for incidental, consequential, or punitive damages arising from the implementation or failure to implement requested changes. The Company's liability for direct damages arising from its breach of this Notice shall be limited to actual demonstrable damages up to the lesser of the fees paid by the Customer related to the affected account in the prior twelve months or $5,000, unless otherwise required by law.

GOVERNING LAW; ENTIRE AGREEMENT

This Notice shall be governed by and construed in accordance with the laws of the state of without regard to its conflict of law principles. This Notice, together with any required supporting documentation, constitutes the entire agreement between the parties concerning the requested account changes and supersedes any prior oral or written communications regarding the same.

AUTHORIZATION AND CERTIFICATION

By signing below, the Customer certifies that the information provided in this Notice is accurate and complete, that the signatory is authorized to request the changes identified herein, and authorizes the Company to effect the changes in accordance with the terms of this Notice. The Customer acknowledges that certain changes (including ownership transfers) may require additional documentation, background checks, or fees before they can be completed.

I certify under penalty of perjury that the information supplied in this Customer Account Change Notice is true and correct to the best of my knowledge.

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