WRAP Facility Name Change Form

WRAP Facility Name Change

Facility Name on Current Certificate(Required)

Facility's WRAP ID(Required)

Is your facility currently certified?(Required)

Yes

Facility's New Name(Required)

Facility Address(Required)

Street Address Address Line 2 City State / Province ZIP / Postal Code Country

Contact Name(Required)

First Last

Title

Phone(Required)

Email(Required)

Upload valid business license, reflecting new name(Required)

Max. file size: 50 MB.

Confirmation(Required)

Confirm

I confirm the information above is accurate and I am authorized to submit on behalf of the facility.

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