This is a Merchant DBA/Address Change Form from Woodforest Acceptance Solutions — a simple one-page form used when a merchant needs to update their doing-business-as name or physical address on their existing account.
It covers two types of changes: a DBA name update, an address update, or both at the same time. The merchant provides their merchant number, what they sell, the old and new information, and a signature from the authorized principal listed on the original agreement.