NCC214812_Contact Update Record_20230918

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 9/18/2023 4:16:39 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC214812
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-4812
Original NOI No.* 62693
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
WTA Holdings LLC
Project Name Simply Southern
Address 500 Gallimore Dairy Road,Greensboro, NC
County Guilford
Latitude 36.0672
Longitude -79.9538
Date COC Issued* 08/24/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 336-291-0060
NEW Billing 336-274-7889 ext 238
Telephone No. (Optional)
Change Requested Marisol,Accounts Payable,via email on 9/18/2023
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 09/18/2023