Name Change Form

PDF Version of Form

Please complete and return to Bankers Leasing Company via email to, fax to 800-342-6855 or mail to PO Box 7740, Urbandale, IA 50323. If you have any questions please contact customer service at 800-247-8136 x 1662.


To submit an application online, complete the simple form below:


Lease # *


Customer # *


Legal Business Name *


Has the company been sold? *


New Information *


New Name


Equipment Information *


City *

State *

Zip *


Billing address is same as physical address


Billing Address






Current Phone Number


Current Fax Number


Email Address




By entering in the name and date you are authorizing Bankers Leasing Company to make the requested changesabove to your account.


Authorized By *


Date *