State of Washington
Business Licensing Service
PO Box 9034
Olympia WA 98507-9034
1-800-451-7985
BLS@dor.wa.gov
Fax: (360) 705-6699
Business Information Change Form
This form can be used for simple changes for your business account. The Business Licensing Service will contact you if
additional forms or fees are required.
A Account information currently on file
Name of an owner, partner, officer, or LLC manager/member Last, first, middle
Business Name/Trade Name Current UBI number Required
B Information to be changed
Use this form only for the following changes.
Cancel the following trade name(s): __________________________________________________________
This will not cancel a corporation name. To cancel a corporation name visit www.sos.wa.gov
To add a trade name, use the Business License Application at bls.dor.wa.gov/addtradenames.aspx
Change mailing address to: ________________________________________________________________
Include street address of the mailing/payroll address city, state and zip. Cannot be used to change a Corp. Registered Agent address.
Change location address to: ________________________________________________________________
Please include street address, city, state and zip. Cannot use a PO Box or PMB as a physical/location address.
Old location address: _____________________________________________________________________
Change phone number to: ( ________ ) ______________________________________________________
Change email address to: _________________________________________________________________
Change owner’s legal name to: _____________________________________________________________
To change ownership structure, e.g., sole owner to corporation, or to assume an existing business,
visit bls.dor.wa.gov/changeownership.aspx
Owner’s prior name: ______________________________________________________________________
Add or Remove spouse name: __________________________________________________________
Effective date: Reason for adding or removing name: _______________________
Close location address: ___________________________________________________________________
Close account at: (To close a corporate account with Secretary of State - visit www.sos.wa.gov)
Dept. of Revenue Employment Security Labor & Industries UBI
Date business closed: _________ Date last wages paid: ____________________________________
Reason for account closure: _______________________________________________________________
Other information: ___________________________________________________________________________
Signature of owner/officer
X
Email address Date signed Phone number
For assistance or to request this document in an alternate format, please call 1-800-451-7985. Teletype (TTY) users may use the Washington Relay Service by calling 711.
BLS-700-160 (12/15/16)
