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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 /> Microsoft account manager email address: <br /> d. Media delivery contact(DO NOT COMPLETE,;It=ATTACHIN"G MEDIA ELECTION FORM). <br /> This is the contact at the ship to/electronic delivery address <br /> ® Same as notices contact and Online administrator <br /> Name of entity* <br /> Contact Warne First* Last* <br /> Contact email address(requiredfor onlme access)* <br /> Street addres's (no.PO boxes accepted)* <br /> City* State/Province* <br /> Postal code* - <br /> (For U.S. addresses, please provide th' +4, e g xxxxx xxxx) <br /> Country* <br /> Phone* Fax <br /> e. Online Services 'Manager. This contact,is authorized to manage the Online Services, <br /> ordered under the Enrollment and (for applicable Online Services) to add or reassign <br /> Licenses, step-up, and initiate Transitions prior to a true-up order:' <br /> ® Same as.notices contact and Online Administrator <br /> 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 /> 30 <br />