Address Birthdate Social Security Number
(Circle all that apply)
NOTE: To change anything other than an address requires additional documentation.
Please contact Shareholder Records for more information.
Name (please print):
Date of Birth:
Social Security Number:
Minor shareholders in household:
Check box if you wish to Receive your Annual Meeting materials electronically
; by providing your email
address you will also receive
I certify that the information provided on this form is true and correct to the best of my knowledge.
Signature: Effective Date:
You must print this form, SIGN it, and mail or fax it to:
1 Doyon Place, Suite 300
Fairbanks, AK 99701
Phone: (907) 459-2040
Fax: (907) 459-2065
Change of Information Form