Notification of Changes for Business Entity
General Information
Business Entity Name:	CRICKET WIRELESS, LLC
Incorporation / Formation Date:
FEIN:	80-0818212
Ohio License Number:	1081497
NPN:	16913228
DBA / Trade Name:
State of Domicile:	DE
County:	USA
Business Address
Address 1:	1025 LENOX PARK BLVD
Address 2:
City:	ATLANTA
State:	GA
Zip:	30319
Phone:	800-274-2538
Fax:
Business Web Site Address:
Business Email Address:	CRICKET@ASURION.COM
Mailing Address
Address 1:	11460 TOMAHAWK CREEK PKWY
Address 2:	STE 300
City:	LEAWOOD
State:	KS
Zip:	66211
Indicate the type of change you are seeking
Address Change:	NO
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
TIFFANY BAEHMAN	VP MARKETING	487-64-6643	YES		04/12/2018
DONNA ORBAN	SR PRODUCT MARKETING MGR	374-74-6305		YES	04/12/2018

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:	LAURA ASKEW
Title:	SR LICENSING COORDINATOR
Phone Number:	816-237-3587
Email Address:	LAURA.ASKEW@ASURION.COM