Change of Address
CUSTOMER STORIES
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EDEX INFORMATION SYSTEMS
Company Name
Party Type
YOUR COMPANY CONTACT INFORMATION
PHYSICAL ADDRESS
MAILING ADDRESS
NOTE FOR EMPLOYERS and PARTY TYPE “OTHER”
All employers, and any entity that selects party type “OTHER” in the box above, is required to serve this change of address
notification to case participants. You can choose to perform the notifications yourself, or ask us to serve notifications for you.
After you submit the information above, you will receive an email document pre-populated with your address changes. Please
sign the form and fax it to us at (209) 231-6700 or email it to support@edexis.com.
Full Name
Phone:
Email address:
Enter your OLD physical address:
YOUR COMPANY INFORMATION
Enter your NEW physical address:
Enter your OLD mailing address:
Enter your NEW mailing address:
SUBMIT
Has Your Mailing or Physical Address Changed?
Let us help you update it with the DWC.
Claims Administrators, representatives, and lien claimants can update the EAMS database with one request. When the addresses are updated,
both pre-existing cases and new cases will reflect the new address. By regulation, all employers and non-UAN parties are required to notify the
district offices and all case participants of changes of name, mailing address, or telephone number. EDEX Information Systems can help you
manage each step of this process. Please complete and submit the form below.
YOUR EAMS ADMINISTRATOR CONTACT INFORMATION
Full Name of Your EAMS Administrator (if applicable)
Email address for Your EAMS Administrator (if applicable)
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