This form should be mailed to:

Name of Applicant:              
Persons Receiving Mail:     
Forwarding Address:            
City/State/Zip:                       //
Emergency Phone Number:
Mother's Maiden Name:     (to be used as your "code word" for address changes)
E-Mail Address:*                
*(A note about e-mail addresses: We will never use your e-mail address for anything other than notifying you about your mail, or to clarify an address.  
We will not use it for any other purpose, nor will we share it with anyone else, for any reason.  We abhor spam, and absolutely will not contribute to it!)

Please Forward our mail: (Please Check One) (You can change this anytime, as needed)

Enclosed: (Please Check One)

Amount Enclosed:

Signature/date:___________________________________________________ / ____________________

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

Mail Forwarding Services
PO Box 190
Jefferson, OR 97352-0190

2.1