CHANGE OF ADDRESS FORM
Please complete the information below and return to PACT. Be sure to include the
purchaser’s signature since the purchaser is the owner of the account and is the only one
authorized to make changes to the account. If you have any questions, please call us at 1-
800-252-7228. Please note that all legal name changes require copies of the appropriate
legal documentation (such as your marriage certificate).
Purchaser's New Address (Please Print)
Street: Apt#:
City: State: Zip:
County:
Phone Numbers: Home ( ) Work ( )
Email Address:
Beneficiary's New Address (Please Print)
Street: Apt#:
City: State: Zip:
County:
Phone Numbers: Home ( ) Work ( )
Purchaser’s Signature __________________________________ Date ___________
Mail to: PACT
P.O. Box 12865
Birmingham, AL 35202-2865
Fax: 1-800-830-7390