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Shareholder Information Change Form
Dear Member,
Please see if your listing is correct. If you find an error please make a correction on this form and give it to President, Ron Schafer. The correction will be made. Thank you for your patience and understanding. We would appreciate a periodic check of your member information and updates as needed.
Name Okay ______ Address Okay ______ Phone/Fax/E-mail Okay _____
THE FOLLOWING CORRECTION IS NEEDED:
Name _______________________________________________
Group # _______________
Address ______________________________________________
_____________________________________________________
Phone # ( )__________________________
Fax # ( ) _____________________________
E-mail ________________________________________________
Signed _________________________________________________
Date ___________________