Change Information


Circulation: 203-634-3933 Email:circulation@record-journal.com
Call us: Monday - Friday, 5:00 a.m. to 2 p.m. Saturday & Sunday, 5:00 a.m. to 10 a.m.

 
 
Change of Information Form
 
Please fill out the form below to notify us of your change of information.
Required fields are marked with an asterisk (*).
 
Current Information
 
* First Name: 
 
* Last Name: 
 
* Address Line 1: 
 
Address Line 2: 
 
* City: 
 
* State: 
 
* Zip: 
 
Business: 
 
* Home Phone: 
 
  Please include the area code.
 
Daytime Phone: 
 
* Email: 
 
  A confirmation email will be sent to the email address entered here.
 
Type of Change(s)
 
Please indicate what information is being updated.
 
    Name Change(s)
 
    Address Change(s)
 
    Billing Information Update
 
    Contact Information Update (Phone/Email)
 
    Business Information
 
New Information
 
Provide your new/updated information in the fields below.
 
First Name: 
 
Last Name: 
 
Address: 
 
City: 
 
State: 
 
Zip: 
 
Billing Information: 
 
Home Phone: 
 
Daytime Phone: 
 
Email: 
 
Business Information: 
 
Effective Date
 
Please specify when your changes should take effect.
 
* Effective Date: 
   
 
  Please allow two (2) business days for changes to be updated.
 
 

Subscription - Change of Information

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