Form ATU-085
ATU REQUEST FOR NEW/CORRECTED ADDRESS Date: _______________
BEFORE ENTERING YOUR REQUISITION, provide information on the new address or correction to an
existing address and fax this form to the Purchasing Department (968-0633). Purchasing will enter the
new address or correct the existing one, note the assigned address number and return this form to the
fax number listed below. Please indicate any address numbers that need to be deleted. If you have
questions or need assistance, please call 968-0269.
From: ________________________________ ___________________________
(Department Name) (Departmental Fax No)
ACTION REQUESTED: _____ Additional Address _____ Change Existing Address
_____ Address Number to be Deleted
Name of Company or
Sole Proprietor
Dba
Street Address
PO Box
City, State, Zip
Telephone Number
Fax Number
Web Site
E-mail Address
Requested By: ____________________________________________
(Signature)
Approved By: ____________________________________________
(Signature of Immediate Supervisor)
FOR PURCHASING USE:
Date
Entered
Initials
