Fields marked with * are required.
Date
Name
Owner Number
Last Four of SSN / Tax ID
Phone Number
Email
Old Address
New Address
Comments/ Questions
By submitting this form, I verify that I am the above-named person, and I authorize Magnolia to make this requested address change.
* This form submits information via e-mail which is inherently insecure. Please do not include ANY personal information that you do not wish to be shared with others.