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Modify a DDS EasyLink Account

Use this form to modify an existing EasyLink account.EasyLink will make these changes within 48 hours of receipt and will confirm the changed information to the e-mail addess specified below. Please note this form can be used to change one user name at a time.

 1. Are you:     ( * Required )
  An Agency / Buying Service
  A Rep
   
 2. Your Name:
* First Name:
* Last Name:
  Attention! Receiving Easylink confirmations solely depends upon a correct email address being entered into the following field. Please verify the email address before submitting this request.
* Email Address:
* Phone:
   
 3. Account Information:
* DDS User ID:  
Example: SJNY - EasyLink refers to this as the EasyLink User Name
* EasyLink ELN
  Specify the type of modification you would like to make to your EasyLink Account and provide the information in the appropriate section. Only selected items will be processed by EasyLink:
  Fax Number for Cancellations
Company Information
User Contact Information
Billing Information
   
 4. Fax number where you wish to receive cancellations:
Primary Fax Number:
Secondary Fax Number:
   
 5. Company Information
Company Name:
Street Address:
City:
State:
Zip:
Phone:
   
  6. User Contact Information:
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Phone:
Email:
   
 7. Billing Information
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Phone:
Email: