Change Of Name Or Address Request - Oregon Department Of Consumer & Business Services
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1Oregon Department of Consumer & Business Services
Division of Finance & Corporate Securities
350 Winter St. NE, Rm. 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
(503) 378-4140 Ÿ Fax: (503) 947-7862 Ÿ TTY: (503) 378-4100
CHANGE OF NAME OR ADDRESS REQUEST
Current license name:
ML:
DBA/ABN:
Type of change request:
Name change applies to:
Company name
Add DBA/ABN
Remove DBA/ABN
Address change applies to:
Primary location
Branch #
location
New information:
Effective date of change:
Final license name:
ML:
Final DBA/ABN:
Location address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone numbers:
Remains the same
New numbers
Telephone:
(
)
-
Fax:
(
)
-
Toll free:
(
)
-
E-mail:
Contact name:
Title:
Phone number:
(
)
-
Check list of other documentation needs:
Rider to surety bond showing final name or address after change.
Copies of Oregon business registry change request of name or address.
Copies of changed licenses in state of primary location (other than Oregon).
Transmittal (cover) letter describing change and signed by authorized representative.
Disclosure of Significant Developments [OAR 441-860-0070(1)] A licensee shall be required to notify the Director
within 30 days of the occurrence of any ... significant developments.
Change of name or address request
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440-3919 (7/04/COM/WEB)
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