HomeMy WebLinkAboutMicrosoft City of Auburn0® Microsoft
Program Signature Form
Volume licensing
MBA/MBSA number 5-0000005085681
Agreement number 01 E73965
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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.
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.
Contract Document,
<Choose A reement>
umber or Code
Document Number�or. Code
<Choose A reement>
Document Number;or,Code.. .
<Choose A reement>
Document Numberor Code
<Choose A reement> A&
.D_oddment
<Choose A reement> . N?{
i".Document Number or`,,Code
<Choose Enrollment/R6 9i'straf llt; t Document Number o'r Code. ,4,'A4
<Choose EnrollmentlRNIs iation> ,
,,' :,''X Document Num, eF o Code` r
<Choose,F_ r Ili%en$Re' istration>
`i t Document'Num�e$'or Code=-
<Choose E' ollment/Re istration> Document ,'umbdedt`:
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Microsoft Corporation
Signature
Printed First and Last Name
Printed Title
Signature Date
(date Microsoft Affiliate countersigns)
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Agreement Effective Date 3 1172&(may be different than Microsoft's signatureY2-10
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a® Microsat
Microsoft Corporation
MAR 18 2020
Laura Merchant
Authorized on behalf of
Optional 2nd Customer signature or Outsourcer signature (if applicable)
Name of Entity (must be legal entity name)*
Signature* r '`
Printed First and Last Name*
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Printed Title t �.
Signature Date*
*indicates required field)5ti ti {
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Name of Entity (must be legal entity name)*,- � S i. C;.:�
Signature*
Printed First and Last Name*
Printed Title !'-
Signature Date*
6* indicates required field
If Customer requires additional contacts or is reporting multiple previous Enrollments, include the
appropriate form(s) with this signature form.
After this signature form is signed by the Customer, send it and the Contract Documents to Customer's
channel partner or Microsoft account manager, who must submit them to the following address. When
the signature form is fully executed by Microsoft, Customer will receive a confirmation copy.
Microsoft Corporation
Dept. 551, Volume Licensing
6100 Neil Road, Suite 210
Reno, Nevada 89511-1137
USA
ProgramSignForm(MSSign)(NA,LatAm)ExBRA(ENG)(Oct2019) Page 2 of 2
Document X20-12845