Information Change Form FULL PRIMARY LAST AND FIRST NAME ON ACCOUNT (REQUIRED) ACCOUNT # (REQUIRED) YOUR REPRESENTATIVE AT COLONY RIDGE (REQUIRED) OLD ADDRESS ON FILE (REQUIRED) OLD PHONE # (1) ON FILE (REQUIRED) KEEP PHONE # (1)REMOVE/CHANGE PHONE # (1) OLD PHONE # (2) ON FILE KEEP PHONE # (2)REMOVE/CHANGE PHONE # (2) OLD EMAIL # (1) ON FILE KEEP EMAIL ADDRESS (1)REMOVE/CHANGE EMAIL ADDRESS (1) NEW ADDRESS NEW CITY NEW STATE NEW ZIP CODE NEW PHONE # (1) NEW PHONE # (2) NEW EMAIL ADDRESS (1) I CERTIFY THAT BY SIGNING THIS FORM THAT I AM THE NAMED PERSON ABOVE. IF I AM NOT THE NAMED PERSON ABOVE, BY POWER OF ATTORNEY, I HAVE PERMISSION TO SIGN ON BEHALF OF THE SAID PERSON ABOVE. COLONY RIDGE WILL NOT BE HELD LIABLE FOR CHANGES MADE DUE TO FALSE CLAIMS MADE ON THIS FORM. SIGNATURE (REQUIRED) (PLEASE ENTER YOUR NAME AS A SIGNATURE) Δ
