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3 <br /> • <br /> • <br /> fax ID N/A Effective Date <br /> (may be different than Microsoft's signature date) <br /> *indicates required field <br /> Optional 2nd Customer signature or Outsourcer Signature (if applicable) <br /> Customer I Outsourcer <br /> Name of Entity (must be legal entity name)* Name of Entity (must be legal entity name) <br /> * <br /> Signature* Signature <br /> * <br /> Printed Name* Printed Name* <br /> Printed Title* Printed Title* <br /> Signature Date* Signature Date* <br /> If Customer requires physical media, additional contacts, or is reporting;multiple previous Enrollments, <br /> include the appropriate form(s) with this signature form. If no media form is included, no physical media <br /> will be sent. <br /> After this signature form is signed by the Customer, send it and the Contract Documents to Customer's <br /> channel partner or Microsoft account manager, who must submit them fo the following address. When <br /> the signature form is fully executed by Microsoft, Customer will receive a confirmation copy. <br /> Microsoft Licensings, GP <br /> Dept. 551, Volume Licensing • <br /> 6100 Neil Road, Suite 210 <br /> Reno, Nevada 89511-1137 <br /> USA <br /> Prepared By: Name of Preparer <br /> • <br /> Email of Preparer <br /> ProgramSignForm(MSSign)(NA)(ENG)(Oct2010) Page 2 of 2 <br />