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Lakeland Communications

Name Change Form

Lakeland Communications
825 Innovation Ave.
P.O. Box 40
Milltown, WI 54858
715-825-2171

I would like to update how my name appears on Lakeland Communications account.

Account#:

Name as it appears on account currently:

Name as you would like it to appear on account:

Date:

Note: Lakeland Communications may call your telephone number on record once this form is received to verify the accuracy of this request.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

September 25, 2025 10:01 am CDT

Name Change Form Uploaded by Lakeland Communications - info@lakelandteam.com IP 67.164.15.7

September 25, 2025 10:04 am CDT

Kayla Pilz - kaylap@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

September 25, 2025 10:11 am CDT

Kayla Pilz - kaylap@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

September 26, 2025 9:42 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

September 26, 2025 9:44 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 9:16 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 9:44 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 10:30 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 10:44 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 10:47 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 73.70.70.181

October 1, 2025 7:17 pm CDT

Lakeland Team - crichmond@ltbx.net added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 67.164.15.7

October 1, 2025 7:36 pm CDT

Lakeland Team - crichmond@ltbx.net added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 67.164.15.7

October 1, 2025 8:23 pm CDT

Lakeland Team - crichmond@ltbx.net added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 67.164.15.7

October 1, 2025 8:30 pm CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 67.164.15.7

October 2, 2025 9:36 am CDT

Lakeland Team - info@lakelandteam.com added by Lakeland Communications - info@lakelandteam.com as a CC'd Recipient Ip: 67.164.15.7