Student Account Billing Address Change Form

							Please complete and return to:

Brown University
Bursar’s Office
Box 1839
Providence, RI 02912


Fax: 401-863-7518

YOU MAY E-MAIL US YOUR CHANGE OF ADDRESS – bursar@brown.edu
BE SURE TO INCLUDE YOUR STUDENT IDENTIFICATION NUMBER!




               STUDENT ACCOUNT BILLING ADDRESS CHANGE FORM

STUDENT ID:____________________________DATE:___________________________


STUDENT NAME: _________________________________________________________


NEW BILLING ADDRESS:
                                 _______________________________________________

                                 _______________________________________________

                                 _______________________________________________

                                 _______________________________________________


TELEPHONE: _______________________________________________

EFFECTIVE DATE OF CHANGE: ___________________________________________

STUDENT SIGNATURE: ___________________________________________________


** NOTE: If this is a permanent address change you must notify the Registrar’s Office. **

                                               OFFICE USE

Completed by: ____________________________         DATE: _____________________________________