AS/PMM/PYS Organizational Update

Organization Name (may not accept punctuation) *

Primary Account Holder Name *

Email Address *

Account Code (Can be found in upper right corner of invoice) If you do not know this, please put an invoice number associated with your account. *

Type of Change Requested *

Address Only

Admin Contact and Billing Contact Only

Billing Contact and Credit Card Update Only

Admin Contact Only (admin is the person that administers your account)

Admin and Address Only

Address, Admin Contact and Billing Contact

Credit Card Update Only

Organization Name Change (names are unique for our system; will require updated letter head or a tax form)

Billing Contact Only (where invoices get emailed)

Admin Contact Name *

Admin Contact Email Address *

Old Organization Name *

New Organization Name *

NAME CHANGE ONLY: Upload tax form showing new legal name or a written request on company letterhead *

username (if you would like to change ONLY)

password (if you would like to change ONLY)

Billing Contact Name *

Billing Contact Email Address *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Update Billing Information *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Billing Address *

Address Line 2

City *

State *

Zip Code *

Would you like to keep this credit card on file for future invoices? *

Yes, keep on file

No, not at this time

Routing Number *

Account Number *

Name on Account *

Account Holder Type *

Account Type *

If your-E-Check is returned due to cancelled account, insufficient funds, no account, or invalid account number there will be a fee of $25 added to your account balance.

Would you like to keep this information on file for future invoices? *

Yes, keep on file

No, not at this time

If needed, you may leave a note for customer service.