Transcription of Home Improvement Contractor Address Change Form
1 HIC-ACRA form -Rev. 7/28/17 New Jersey Office of the Attorney GeneralDivision of consumer AffairsOffice of consumer ProtectionRegulated Business Section124 Halsey Street, 7th Floor, Box 46016, Newark, NJ 07101 Home Improvement Contractor Address Change form Information that you provide on this application may be subject to public disclosure as required by the Open Public Records Act (OPRA). Instructions: Please print clearly. Complete all of the items below (one through six). Return the completed form to the mailing Address listed above. 1. Registration Number: Date: 2. Name of Individual Completing this form : Title: 3. Business name as it appears on the HIC Registration: Telephone Number (include area code): E-mail Address : 5. Mailing Address if different from above.
2 City: State: ZIP Code: OLD Address NEW Address 5. Old Business Address : City: State: ZIP Code: FOR OFFICIAL uSE ONLy 6. Old Business Address : City: State: ZIP Code: Date Revised: Initial: Date: 4. New Business Address (Must be a street Address ): City: State: ZIP Code:OLD Address
