Customer Change Form and Agreement

Customer Change Form and Agreement INSTRUCTIONS  Please follow these instructions to change the named customer on your account to another person. If you just want to change the last name of the person that is already the named accountholder, please chat with a live representative using the Ask Charter feature or call 1‐888‐438‐2427. 
The current named customer must type or print their information into Part A. The new person that wants to be the named customer must type or print their information into Part B. If Charter Voice is included on the account, you must decide whether to have a private listing for an additional charge and, if listed, how your first and last name should be formatted. The appropriate documentation must be included with the form: 
Type Change due to disability or incapacitation Military leave Changed name due to marriage or civil union Change due to divorce Other changes of named customer 
140421 Required Documentation Signed power of attorney or conservatorship If both parties cannot sign, submit copy of active duty or deployment order In‐person: show government issued ID with new name By fax: copy of government issued ID with new name If both parties cannot sign, submit a copy of divorce decree, certificate of divorce or court order In‐person: show government issued ID By fax: copy of government issued ID for current and new accountholder or stamped by notary Except as noted above, both the current and new customer must sign and date the form. The completed form and documentation can be returned to your local Charter Store TIP Find your local Charter Store at‐locations or Mailed or faxed to: Strategic Accounts 941 Charter Commons Drive Town and Country, MO 63017 Fax: 636‐207‐5130 (preferred) Customer Change Form and Agreement « PLEASE PRINT LEGIABLY » A. Current Customer Account Number: Service Address: First and Last Name: B. New Customer Primary Contact Number: Secondary Contact Number: First and Last Name: Email Address: (optional) New PIN: (optional, four digit number) Private Directory Listing:  No (default)  Yes (add’ll monthly charge may apply) Charter Voice Only: Directory Format:  Full Name (default)  First Initial & Last Name Current Customer: You hereby request that Charter transfer your account, including any services, equipment, rights and information, to the above named new customer. You will make arrangements directly with the new customer for the payment of any existing balance on your account. You are responsible for the transfer of all Charter equipment to the new customer. You acknowledge that the equipment and account records will include information about you, your use of the service and historical information about your account. After the transfer, this information will be accessible to the new customer and other users. New Customer: You hereby agree to transfer the above named Charter account and assume all obligations, including any existing equipments, packages and outstanding balances, into your name. You will become legally responsible for this account, paying any balance owed and acknowledge that the account will be transferred with the existing pricing and packaging. You accept responsibility for the equipment currently assigned to the account and understanding that you must return all Charter equipment or pay the applicable unreturned equipment fee. If Charter Voice is provided, you also acknowledge that our Charter Voice service is provided using a telephone modem that requires electrical power at your residence. As is the case with cordless phones, Charter Voice equipment will not work in the event of a power outage, and you will not be able to make or receive calls, including 911 calls, unless you have a battery‐slotted modem and you have purchased and installed a battery. You acknowledge that you have received a Welcome Kit, Privacy Policy and Terms and Conditions of Service which are also located at You agree to be bound by the applicable Terms and Conditions of Service, and agree that your continued use of Charter’s services shall constitute your acceptance of any future changes. BY SIGNING BELOW, THE CURRENT CUSTOMER AND NEW CUSTOMER REPRESENT THAT THEY EACH ARE AT LEAST 18 YEARS OLD; THEY ARE THE ABOVE NAMED INDIVIDUALS AND ARE THE OWNER AND/OR TENANT OF THE PREMISES SET FORTH ABOVE; AND THAT THEY ARE AUTHORIZED TO MAKE THE REPRESENTATIONS AND AGREE TO THE TERMS AND CONDITIONS SET FORTH HEREIN. Current Customer’s Signature Date New Customer’s Signature
Notary Validation | Only necessary for mailed/faxed forms without supporting documentation Mail or fax completed documents: Strategic Accounts 941 Charter Commons Drive Town and Country, MO 63017 Fax: 636‐207‐5130 « DO NOT FORGET TO INCLUDE ANY REQUIRED DOCUMENTATION » 140421 Internal Only:  Faxed to SA  EE Acct