Name Change Form

PDF Version of Form

Please complete and return to Bankers Leasing Company via email to welcometoblc@banleaco.com, 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

 

City

State

Zip

 

Current Phone Number

 

Current Fax Number

 

Email Address

 

Comments

 


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

 

Authorized By *

 

Date *