L. BROOKS PATTERSON, OAKLAND COUNTY EXECUTIVE VENDOR CHANGE REQUEST County of Oakland Department of Management & Budget Fiscal Services Division Executive Office Building 2100 Pontiac Lake Rd Waterford MI 48328 Phone (248) 858-5489 Fax (248) 452-2148 FEDERAL TAX IDENTIFICATION NUMBER (Use Social Security Number if sole proprietor) Date Requesters Signature Requesters Name (Please Print) TIN Please type or print clearly. SSN Requesters Phone Number Un-Signed change forms will be returned to you. Change Business Name Only (Any change in a Business Name requires a W-9 to be submitted with this form) Change Business Address Only Change Both Business Address and Remittance Address Change Contact Person Change E-mail Address Old Business Name and Address Legal Business Name Change Remittance Address Only Change Phone Number Change Fax Number New Business Name and Address Legal Business Name Address Line One Address Line One Address Line Two Address Line Two City State Zip+4 City State Zip+4 (Area Code) Phone (Area Code) Fax (Area Code) Phone (Area Code) Fax Contact Person Contact Person E-mail Address E-mail Address Old Remittance Address Legal Business Name New Remittance Address Legal Business Name Address Line One Address Line One Address Line Two Address Line Two City State Zip+4 City State Zip+4 (Area Code) Phone (Area Code) Fax (Area Code) Phone (Area Code) Fax Contact Person Contact Person E-mail Address E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com Revised 4/2014