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Mkrosoft I Volume Licensing <br />Supplemental Contact Information Form State and Local <br />This form can be used in combination with Agreement and Enrol Iment/Registration. However, a <br />separate form must be submitted for each Enrollment/Registration, when more than one is submitted <br />on a signature form. For the purposes of this form, "Entity" can mean the signing Entity, Customer, <br />Enrolled Affiliate, Government Partner, Institution, or other party entering into a Volume Licensing <br />program agreement. Primary and Notices contacts in this form will not apply to Enrollments or <br />Registrations. <br />This form applies to: ❑ Agreement <br />❑ Enrollment/Affiliate Registration Form <br />Insert primary entity name if more than one Enrollment/Registration Form <br />is submitted <br />Contact information. =E, <br />Each party will notify the other in writing if any of the information in the following contact information <br />page(s) changes. The asterisks (*) indicate required fields; if the Entity chooses to designate other <br />contact types, the same required fields must be completed for each section. By providing contact <br />information, entity consents to its use for purposes of administering the Enrollment by Microsoft and other <br />parties that help Microsoft administer this Enrollment. The personal information provided in connection <br />with this agreement will be used and protected according to^ pracy statement available at <br />htt s://licen ' icrosoft.com. <br />1. Additional notices contact. . <br />This contact receives all notices that are sent fl Microsoft.o online access is ranted to this <br />� 9 <br />individual. <br />Name of Entity* <br />Contact name*: First Last <br />Contact email* <br />Street address* <br />City* State* Postal code* <br />Country* <br />� <br />Phone* Fax <br />❑ This contact is a third party (not the Entity). Warning: ct receives personally identifiable <br />information of the Entity. <br />J <br />2. Software Assurance manager. <br />This contact will receive online permissions to na the Software Assurance benefits under the <br />Enrollment or Registration. <br />Name of Entity* W\�6,4 <br />Contact name*: First <br />Contact email* <br />Street address* <br />City* State* <br />Country* <br />Phone* Fax <br />Last <br />Posta* <br />SupContactl nfoForm(US)SLG(EN G)(Oct2010) <br />Page 1 of 3 <br />147 <br />