Consolidated Ace Hardware

ACCOUNT UPDATE FORM

ACCOUNT NAME: ____________________________________________

ACCOUNT NUMBER: __________________________________________

PLEASE COMPLETE ALL INFORMATION BELOW SO THAT WE MAY DO A COMPLETE UPDATE OF OUR RECORDS ON YOUR ACCOUNT AT THIS TIME.

REASON FOR UPDATE:   ___ USER CHANGE       ___ CONTACT PERSON CHANGE

  (Please check one)              ___ CLOSE ACCOUNT  ___ INFORMATION CHANGE

E-MAIL INVOICES & STATEMENT_______________________________________

                                                                            (E-mail address)

LIST ALL AUTHORIZED USERS.  ALL OTHERS WILL BE DELETED:

(Attach additional sheet with printed name and signature if needed.)

1.___________________________   5. ___________________________

2.___________________________   6. ___________________________

3.___________________________   7. ___________________________

4.________________________________   8. ________________________________

CURRENT ADDRESS:

Street: _______________________________________________________

City ______________________________________ST ____Zip _________

P.O. Box: _____________________________________________________

City ______________________________________ST ____Zip__________

Phone #: (____) ___________________Fax #: (_____) _________________

Cell #: (_____) ___________________

AUTHORIZED SIGNATURE FOR CHANGES:

Printed Name: __________________________________________________

Date: _________________________________________________________

Please return form to: acctsreceivable@consolidatedace.com or fax to: (850) 892-6527.  If you have any questions, please call (850) 892-7283.