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grant online access to others , and (3) is authorized for applicable Online Services to add or <br /> reassign Licenses , step-up , and initiate Transitions prior to a true up order. <br /> ® Same as primary contact <br /> Name of entity* <br /> Contact name* First Last <br /> Contact email address* <br /> Street address* <br /> City* State/Province* <br /> Postal code* - <br /> ( For U . S . addresses , please provide the zip + 4 , e . g . xxxxx-xxxx) <br /> Country* <br /> Phone* Fax <br /> Language preference. Choose the language for notices . English <br /> ❑ This contact is a third party ( not the Enrolled Affiliate) . Warning : This contact receives <br /> personally identifiable information of the Customer and its Affiliates . <br /> c. Microsoft Account Manager, Microsoft Account Manager for this Enrolled Affiliate is : <br /> Microsoft account manager name : <br /> � h `n <br /> Microsoft account manager email address : ~~~~~ <br /> d . Media delivery contact ( DO NOT COMPLETEAF ATTACHIN0 1111EDIA ELECTION FORM ). <br /> This is the contact at the ship to/electronic delivery address T s ' <br /> ® Same as notices contact and Online Adrn ►nlstrator <br /> Name of en I I INr � <br /> Contact narjneFtst* Last* f <br /> Contact eII m'a address ( required for online accesIN <br /> s)* T: <br /> I . <br /> .Street address ( no PO boxes accepted)* rlerr <br /> City* Statelprovince" <br /> Postal code* " ' <br /> rL <br /> 41 <br /> For U . S . addresses , lease rovide fhe � IN <br /> IN <br /> ( p p ip + 4 , e g xx�goc xxxx) <br /> Country* } <br /> Phone* Fax rte; <br /> y, <br /> e Online"ervices , Manager. This contact .,.,ls , authorized to manage the Online. Services, <br /> . . fiord&e% d under the Enrollment and (for applicable Online �Servlces) to add or reassign <br /> , icenses , step-up , and initiate Transitions_ prior to a true-up order <br /> rr <br /> I <br /> ® = Same, as notices contact and. Online Administrator <br /> IN ,. . Name of entity* _ <br /> Contact name* : First Last <br /> Contact email address* <br /> Street address* <br /> City* State/Province* Postal code* <br /> Country* <br /> Phone* Fax <br /> ❑ This contact is from a third party organization ( not the entity) . Warning : This contact <br /> receives personally identifiable information of the entity. <br /> f. Reseller information , Reseller contact for this Enrollment is : <br /> Reseller company name* SHI International Corp <br /> Street address ( PO boxes will not be accepted )* 290 Davidson Ave <br /> City* Somerset State/Province* NJ Postal code* 08873 <br /> Country* USA <br /> Contact name* Daniel Bellinger <br /> EA2011EnrGov(US) SLG(ENG)(Ju12011 ) Page 10 of 14 <br /> Document X20-02113 <br />