HomeMy WebLinkAboutMicrosoft Volume Licensing Form * Microsoft Volume Licensing
Program Signature Form
MBA/MBSA number Proposal ID
Agreement number 6211966
Note: Enter the applicable active numbers associated with the documents below. Microsoft
requires the associated active number be indicated here, or listed below as new.
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This signature form and all contract documents identified in the table below are entered into between
the Customer and the Microsoft Affiliate signing, as of the effective date identified below.
Number or Code
Contract Document
<Choose Agreement> Document Number Of Co,,, e
<Choose Agreement> Document umber or
<Choose Agreement> °� ��
g ,',Document l reber ory
<Choose Agreement .a. Document Number or ;ode :,,,,,L.,,,,,,,11:6: mm
<Choose Agreement> i DocumentNur�or Code ':•;
Select Plus Affiliate Registration Form X20-11, 9 , ,ill,
<Choose Enrollment/Registration> current Number or Code
<Choose Enrollment/Registration> ` Document Number or Code
<Choose Enrollment/Registration> Document Number or Code
�� Enollment/Registration> Document Number or Code
By signing below, Customer and the Microsoft Affiliate agree that both parties(1) have received, read
and understand the above contract documents, including any websites or documents incorporated by
reference and any amendments and (2) agree to be bound by the terms of all such documents.
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ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(Oct2o13)
Customer
Name of Entity(must be legal entity name)*CITY OF OAK PARK HEIGHTS
Signature* , ,,.J
Printed First and Last Name*GARY BRUNCKHORST
Printed Title SR.ACCOUNTANT
Signature Date* 3/21/2014
Tax ID LA ` — 0 0 1053
*indicates required field
Microsoft Affiliate
Microsoft Licensing, GP
Signature
Printed First and Last Name
Printed Title
Signature Date
(date Microsoft Affiliate countersigns)
Agreement Effective Date
(may be different than Microsoft's signature date)
Optional 2"d Customer signature or Outsourcer signature(if applicable)
Customer
Name of Entity(must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
*indicates required field
0 utsourcer
Name of Entity (must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
*indicates required field
If Customer requires physical media, additional contacts, or is reporting multiple previous Enrollments,
include the appropriate for with this signature form.
After this signature form is signed by the Customer, send it and the
Customer's channel partner or Microsoft account manager, who must submit them Contract to Documents the following to
Page 2 of 3
ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(Oct2013)
address. When the signature form is fully executed by Microsoft, Customer will receive a confirmation
copy.
Microsoft Licensing, GP
Dept. 551, Volume Licensing
6100 Neil Road, Suite 210
Reno, Nevada 89511-1137
USA
4,
ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(Oct2013) Page 3 of 3