Bill to Change Request Form

Thank you for reaching out to Alert Protective, Inc. to change the billing information on your account. Please complete the bill to change request form and click submit. Upon receipt of the completed form, the account will be updated within 3 business days. You may receive a call to confirm the information.

**Please note: this form only changes the BILL TO information on the account. It does not change the name of the account or ownership.**

Name of Person Submitting Request *

Current Billing Contact Information

Account Number *

Current Name on Account *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number *

Email Address *

New Billing Contact Information

New Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Acknowledgement

I, the undersigned, certify that the information provided above is true and accurate. I understand that any false or misleading information may result in the denial of this request.

Customer Signature *

Date *

Feel free to contact us or give us a call at (855) 422-6700 if you have any questions. Follow us on Twitter, Facebook, and Linkedin for updates on our business.

Protecting the Midwest Since 1982

Bill to Change Request Form