USBA MEMBERS REQUEST FOR ADDRESS CHANGE

When you move, use this form to keep your address and phone number(s) up to date on USBA records. This will insure that important mail from USBA, including dividend payments when applicable, will reach you promptly.

Please print this page, fill it out and mail to:

USBA
P.O. Box 25956
Overland Park, KS 66225-0956

If you prefer, call us TOLL-FREE at (800) 821-7912 or send us an e-mail.

Name:
Member ID Number (Important for Correct Identification):
CURRENT MAILING ADDRESS
Street:
City, State & Zip:
Home Phone:
Work Phone:
E-mail address:
NEW MAILING ADDRESS
Street:
City, State & Zip:
Home Phone:
Work Phone:
E-mail address:
Effective date:
ALTERNATE ADDRESS/HOME OF RECORD This can be the permanent address of a parent or other relative or friend where we can send mail for forwarding to you in the event you fail to notify us of a new address.
Street:
City, State & Zip:
Home Phone:
Work Phone:
E-mail address: