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Subscriber's Change of Address Form

Use this form to report a change of address for your newsletter subscription. To ensure accuracy, please check each entry carefully, especially your e-mail address. Fields marked with an * are required. You can submit this via e-mail using the "Submit" button below, or use phone/fax/mail using the information below.

First Name
*

Middle Initial

Family Name
*

Subscriber Number
(3-6 digit number on label)

Effective Date
(mm/dd/yyyy)
*

E-mail

*
(please double check this entry)

Old Address

Address 1
*

Address 2

City
*

State/Prov
*

Zip/Postal Code

Country

Phone

New Address

Address 1
*

Address 2

City
*

State/Prov
*

Zip/Postal Code
*

Country

Phone

Special Instructions

First Name	*
Middle Initial
Family Name	*
Subscriber Number (3-6 digit number on label)
Effective Date (mm/dd/yyyy)	*
E-mail	* (please double check this entry)

Old Address
Address 1	*
Address 2
City	*
State/Prov	*
Zip/Postal Code
Country
Phone

New Address
Address 1	*
Address 2
City	*
State/Prov	*
Zip/Postal Code	*
Country
Phone

Special Instructions

You may also submit this information using phone/fax/mail. Call 800-326-1896 or 415-289-0501 Mon.-Fri., 9-5 Pacific time, fax to 415-289-0137, or write

Undercurrent
3020 Bridgeway, Sausalito, CA 94965
USA

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