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2. Change of Business Address Request

   This form is to change the address of a business that is relocating within Wellesley.
   

4. Business Information
6. DBA (Doing Business As) Name*
7. Property ID/Account #
9. New Business Address*

   New Wellesley address of business.

10. Date of Relocation*
    Date of Relocation
14. New Mailing Address

    If different from the above.

16. New Mail Address
18. New Mail City
19. New Mail State
20. New Mail Zip Code
24. Contact Infomation and Signature
26. Owner Name*
27. Co-Owner Name
29. Email Address*
30. Phone Number*
32. Electronic Signature*

    By checking the "I agree" box below, you agree and acknowledge that 1) you are the owner of the business identified in this form, 2) your application will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

    1. I agree. Electronic Signature
34. Signed*

    Business Owner

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field