Notification of Changes for Business Entity
General Information
Business Entity Name:	WEST VIRGINIA PCS ALLIANCE, L.C.
Incorporation / Formation Date:
FEIN:	54-1859455
Ohio License Number:	998277
NPN:
DBA / Trade Name:
State of Domicile:	VA
County:	USA
Business Address
Address 1:	1154 SHENANDOAH VILLAGE DRIVE
Address 2:
City:	WAYNESBORO
State:	VA
Zip:	22980
Phone:	540-946-3500
Fax:	540-949-4878
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11460 TOMAHAWK CREEK PKWY, STE 300
Address 2:
City:	LEAWOOD
State:	KS
Zip:	66211
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	KIMBERLY GARBY
Title:	VPGM CLIENT SERVICES
Phone Number:	816-237-3139
Email Address:	NTELOS@ASURION.COM