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Customer <br /> Name of Entity (must be legal entity name)* Microsoft Licensing, GP <br /> Indian River County BOCC <br /> Signature* Signature <br /> Printed First and Last Name* Printed First and Last Name <br /> Printed Title* Printed Title <br /> Signature Date* Signature Date <br /> (date Microsoft Affiliate countersigns) <br /> Tax ID 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 /> CustomerOutsourcer <br /> Name of Entity (must be legal entity name)* Name::`of Entity, (must= be;legal ,e.ntity name)* <br /> t� <br /> Signature* Signature* <br /> �..- <br /> Printed First anal Last Name* Printed First and Last Name* <br /> Printed Title* Pnnted'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 /> charinef partner or Microsoft account manager,,who must submit`them to the following address, ;When <br /> the signature form is fully executed by Microsoft, Customer will receive a confirmation copy. <br /> Microsoft Licensing, GP <br /> Dept. 551, Volume Licensing <br /> 6100 Neil Road, Suite 210 <br /> Reno, Nevada 89511-1137 <br /> USA <br /> Prepared By: <br /> APPROVED AS TO FORN'i <br /> IAH-rl LE AJ SUFF°PilNCY <br /> P CH <br /> � lTYATTORNEY <br /> ProgramSignForm(MS Sign)(NA,LatAm)EXBRA,MLl(ENG)(Oct2011) <br /> Page 2 of 2 <br /> 20 <br />