Change Of Info

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T
B
P
L
S
EXAS
OARD OF
ROFESSIONAL
AND
URVEYING
12100 Park 35 Circle, Building A, Suite 156, MC-230, Austin TX 78753
Phone: (512) 239-5263
Fax: (512) 239-5253
FIRM CHANGE OF INFORMATION FORM
Change requests must be made in writing to the Board. Address changes are made at the request of the Registrant.
*A new return address on letterhead or on an envelope is not considered a request for a change of address.
** Notice by the surveyor is not considered the firm’s notification of change.
Firm Name:
Firm Number:
______________
Address:
Street
City
County
State
Zip
Phone:
E-mail: _____________________________________
Firm Address Change
(No fee required)
New Address:
Street
City
County
State
Zip
New Phone Number:
Email:
Surveyor Change
(No fee required)
Add
Remove
Surveyor Name:
RPLS#
New Firm:
Add
Remove
Surveyor Name:
RPLS#
New Firm:
Name Change
(No fee required)
New Firm Name:
Does this affect all Branches?
Yes
No
If no which branches are affected? Branch number and city:
New Firm Managing Owner(s) with e-mail address (please list position and full name):
______________________________________________________________________________________________
Partner(s), Officer(s) or Director(s) of Firm (please list position and full name):
______________________________________________________________________________________________
Name of Remitter:
Signature:
Date:

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