COmPANy PrOFiLE FOrm

Company Profile Form
Please use this for company address, phone and contact information updates ONLY. To expedite the changes, you can enter
your updates directly online at www.gs1us.org/companyprofile.
Please Note:
1. For Company Prefix Transfer as a result of any change in company ownership. e.g., Merger & Acquisition (M&A), Divestiture,
please use the GS1® Company Prefix Transfer Request Form. The form can be obtained at www.gs1us.org/mergers.
2. For updates and changes associated with Company Name Change or Change in Company’s Business Formation (Inc., LLC,
LLP, etc.) please use the Company Name Change Form. This form can be obtained at www.gs1us.org/mergers.
Company Information
Company Name:
Company Address 1:
Company Address 2:
City:
State:
Company Telephone:
Zip:
Country:
Company Fax:
U.P.C./GS1
Company Prefix(es):
If you have any changes to Company Prefixes listed above, please contact the GS1 USTM Data Maintenance
Team at +1 937.435.3870 or [email protected]
Contact Information (Contacts should be employees of the company, and not solution providers or consultants)
Chief Executive Officer/ Prefix:
Chief Financial Officer:
First Name:
Last Name:
Suffix:
Title:
Email:
Business Address:
State:
City:
Zip:
Telephone:
Country:
Fax:
Key Contact: Prefix:
First Name:
Last Name:
Suffix:
Title:
Email:
Business Address:
State:
City:
Telephone:
Copyright © 2012 GS1 US, All Rights Reserved
Zip:
Country:
Fax:
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Company Profile Form
I declare and affirm under penalty of perjury that the statements made herein are true and correct to the best of my knowledge,
information and belief.
Name of person completing this form
Company Name
Title
Email
Telephone
The completed form can be sent via mail, email or fax to:
Mail: GS1 US, 7887 Washington Village Drive, Suite 300, Dayton, Ohio 45459
Email: [email protected]
Fax: +1 937.435.7317
For questions or assistance completing this form, please call +1 937.435.3870
Copyright © 2012 GS1 US, All Rights Reserved
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