Unclaimed Property Form

Please print this page, complete the form, and mail to:

MDsave Inc.
100 Winners Circle N.
Brentwood, TN 37027

____ The above-referenced address is correct; I am aware of the credit and wish to maintain it with MDsave 

____ I am aware of the credit and wish to maintain it with MDsave. Please change the address on the account to read as follows:

Name ___________________________

Address  _________________________

_________________________________

_________________________________

____ Please send a check for the amount owed to the following address and close my account.

Name ___________________________

Address  _________________________

_________________________________

_________________________________

Signature: __________________________    Date: __________________________