Master License Service
Department of Licensing
P O Box 9034
Olympia WA 98507-9034
Telephone: (360) 664-1400
mls@dol.wa.gov
RESET
BUSINESS INFORMATION CHANGE FORM
This form can be used for simple changes for your business account. Use the Master Application
form for your changes if you have business licenses that are renewed annually. The Master License
Service will contact you if additional forms or fees are required.
ACCOUNT INFORMATION CURRENTLY ON FILE
Current UBI number (required):
Name of an owner, partner, officer or LLC manager/member:
Firm name (doing business as):
INFORMATION TO BE CHANGED
Use this form only for the following changes.
"
Cancel the following Trade Name(s):
This will NOT cancel a corporation name. To add a Trade Name, use the Master Application.
"
Change Mailing Address to:
Include street address of the mailing/payroll address city, state and zip. Cannot be used to change a Corp. Registered Agent address.
Change Location Address to:
"
Please include street address, city, state and zip. Cannot use a PO Box or PMB as a physical/location address.
Old Location Address:
"
Change of phone number:
(
)
Change Owner’s Legal Name to:
"
To change ownership structure, e.g. sole owner to corporation, or to assume an existing business, use the Master Application.
Owner’s prior name:
"
"
Add or
Remove Spouse Name:
"
Close Account at: (Cannot close a corporate account with Secretary of State)
"
Dept. of Revenue
"
Employment Security
"
Labor & Industries
"
UBI Account
Other Information:
"
Please mail me a new Master License.
SIGNATURE OF OWNER/OFFICER:
DATE:
I
f you need assistance through the Telecommunications Device for the Deaf, call TTY (360) 664-8885.
BLS-700-160 UBI CHANGE FORM (R/10/02)OR
To request this document in an alternate format for the visually impaired, call (360) 664-1400.