Change of Address Form lini.com

[Pages:1]Change of Customer Information Form

It is your responsibility to inform the Illinois Ticket Office of any changes in the information we have on file in your customer account. In order to protect your privacy, all changes must be done in writing, using this form and can be faxed directly to the Illinois Ticket Office at (217) 244-4170, or mailed to: 1800 S. First St, State Farm Center, Room 1000, Champaign, IL 61820. If you need assistance with completing this form, you may call our Customer Service Department at (217) 333-3470 or Toll Free (866) 455-4641 and a Customer Service Representative will be happy to assist you. Thank you.

Customer Account Number

Effective Date of Change

Today's Date

Previous Customer Information

Last Name

First Name

Mailing Address

City, State, Zip

Home Telephone

Business Telephone

Middle Initial Email Address Cell Phone

New Customer Information

Mailing Address

City, State, Zip

Home Telephone

Business Telephone

Email Address Cell Phone

Illinois Ticket Office

2141 South Neil Street Champaign, Ill. 61820

217-333-3470 illinitickets@illinois.edu

1-866-ILLINI-1 tickets

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