Contact/Address Change

Inter/National Fraternity/Sorority*

Chapter Name of Fraternity/Sorority*

Legal Name of Housing Corporation Entity*

New Contact Is*

Inspection Contact
Renewal Contact

Physical Address of Chapter Location

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Housing Corporation President

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Housing Corporation Treasurer

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Billing Address

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Inspection Contact

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Who should future billings/correspondence be sent to?*

President
Treasurer
Both

If other, please provide the following

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Comments

Submitter Contact Information

Name*

First Last

Your Title*

Email*

Contact/Address Change

Physical Address of Chapter Location

Housing Corporation President

Housing Corporation Treasurer

Billing Address

Inspection Contact

If other, please provide the following

Submitter Contact Information

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