Name Change Form Your email address * Name currently on the account: Please select the reason for name change on account: * I need to add someone's name to my account I need to remove someone's name from my account I am assuming an existing account to put in my name My name has legally changed and I need to update my account Please fill out the following information for the person you are needing to add to the account. Name to add: * Date of Birth: * Place of Employment: * Driver's License #: * Contact #: * Name to Remove * Name as it should appear on the bill going forward: * Name of person assuming account: * Date of Birth: * Place of Employment: * Driver's License #: * Contact #: * Change name to: * Are there any additional authorized users you'd like to add to the account? * Yes No Name of additional authorized user: * Date of Birth: * Place of Employment: * Driver's License #: * Contact #: * If our Customer Service Team needs to get ahold of you for any reason regarding this order, what number can we reach you at? * Submit Please read the statement and check the box: * I Understand that to assume an existing account, the person who's name the account is under will need to contact Haviland Broadband to give permission for this change. It is up to me to let that person know they need to call in. If you are human, leave this field blank.
