Change of Address

First Name: *

Last Name: *

Previous Name:

If you previously had a different name (married name/name change) while working at Wal-Mart, please let us know in this field

Address 1: *

Address 2:

City: *

State: *

Zip: *

Last 4 of SSN: * ***-**-

In order to assist us in locating your records, please provide us the last four digits of your Social Security Number.

This information will NOT be shared with anyone.

Wal-Mart Iowa Class Action