UA Local 355 | Change Address Form
15368
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Change Address Form

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If you have a change in your address, telephone numbers, Driver’s Licenses expiration dates, or Residence Alien Card expiration dates, please complete this form:

Today’s Date
Name
Date of Birth
Social Security Number
Address
City/State/Zip Code
County
Home Telephone
Cell Telephone
Name and Telephone of person in case of emergency
Driver’s License Number and Expiration
Residence Alien Card Number and Expiration
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You can also download this form and send it to:

Underground Utility/Landscape Local 355
13 Tennessee Street, Vallejo, CA 94590
Telephone: 707­644­0355 Fax: 707­644­0360