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Z Same as primary contact (default if no information is provided below, even if the box is not <br />checked). <br />Contact name* First Basil Last Dancy <br />Contact email address* bdancy@ircgov.com <br />Street address* 1801 27th St. <br />City* Vero Beach <br />State/Province* FL <br />Postal code* 32960 -3388 - <br />(For U.S. addresses, please provide the zip + 4, e.g. xxxxx-xxxx) <br />Country* United States <br />Phone* 772-226-1256 <br />Language preference. Choose the language for notices. <br />❑ This contact is a third party (not the Enrolled Affiliate). Warning: This contact receives <br />personally identifiable information of the Customer and its Affilia` . <br />* indicates required fields <br />c. Online Services Manager. This contact is autho <br />under the Enrollment and (for applicable Onl ne <br />step-up prior to a true -up order. <br />Services ordered <br />gn Licenses and <br />Same as notices contact and,,Online Administrator (iiefault,if no informatiomis provided <br />below, even if box is not checked)\D��ndy,�\ <br />Contact name*: First Basii-Last Contact email address* bdancy@ircgov oni <br />Phone* 772-226-1256 �`�� <br />❑ This contact is from a third party organization (not the entity). Warring: This contact receives <br />personally identifiable,information�`of,the entit . <br />*indicates require�i`fields ,. \� <br />d. Reseller infoi <br />Reseller com <br />Street addres <br />City* Somers <br />By signir <br />Enrollme <br />Signature*_ <br />Printed name* <br />Printed title* <br />Date* <br />* indicates required fields <br />for <br />711 <br />Davidson Ave <br />@shi.com <br />identified above confirms that all information provided in this <br />Changing a Reseller. If Microsoft or the Reseller chooses to discontinue doing business with <br />each other, Enrolled Affiliate must choose a replacement Reseller. If Enrolled Affiliate or the <br />Reseller intends to terminate their relationship, the initiating party must notify Microsoft and the <br />107 <br />