CONF 12/2015
IDHR Public Contracts Change of Company Name Form
State of Illinois
Illinois Department of Human Rights
Legal Division, Public Contracts Unit
Please Submit to:
IDHR.PublicContracts@illinois.gov
OR mail to:
IDHR - PUBLIC CONTRACTS UNIT
100 W. RANDOLPH ST - SUITE 10-100
CHIAGO, IL 60601
IDHR Number (required): FEIN (required):
New Name of Company:
Contact Name: Contact Phone: E-mail:
Former Address:
Former City:
Former. State: Former ZIP: Former County:
New Address:
New City:
New State:
New ZIP: New County:
By Signing Below, I certify that the information provided in this report, and in any attachments thereto, is true and
accurate to the best of my knowledge and belief. The employer filing this report agrees to conform with the requirements
set forth in the Illinois Human Rights Act, 775 ILCS 5/1-101 et seq., and the Rules and Regulations of the Department of
Human Rights. I am authorized to submit this form on behalf of the employer.
Date this Form was Completed
Typed Name and Title of the Person Completing this Form
Signature
Date
OR
Save a copy of this form and attach it
in an email to:
IDHR.PublicContracts@Illinois.gov
MAIL TO:
IDHR - Public Contracts Unit
100 W. Randolph St, Ste. 10-100
Chicago, IL 60601
IDHR PUBLIC CONTRACTS CHANGE OF COMPANY NAME FORM
Note: Your Change of Company Name Confirmation will be sent to the e-mail address you have provided on this form
For Assistance Contact Public Contracts at 312-814-2431
NOTE: If the FEIN is a new number, do not complete this form. Contact the Public Contracts Unit at (312) 814-2431
Former Name of Company:
If the Address has not Changed, Skip this Section
