If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2. Page 2. Telephone. Email.Include the corporation's designated name for use in Virginia, if one was adopted. III Merger, Consolidation, or Conversion. Representative and Address Provisions. aia0083. Request for Withdrawal as Attorney or Agent and Change of Correspondence Address (Private Sector). Alexandria, VA 22313-1450. How to fill out the Artist Management Agreement Sample Document? 1. Enter the full names and contact information of the artist and manager. Sussex County Board of Supervisors Regular Meeting.