HomeMy WebLinkAbout34 - CC-14 - Attachment 2 - 7/21/2015Microsoft
Program Signature Form
MBA/MBSA number
Agreement number 01E73134
ATTACHMENT 2
Volume Licensing
Note: Enter the applicable active numbers associated with the documents below. Microsoft requires
the associated active number be indicated here, or listed below as new.
For the purposes of this form, "Customer" can mean the signing entity, Enrolled Affiliate,
Government Partner, Institution, or other party entering into a volume licensing program agreement.
This signature form and all contract documents identified in the table below are entered into between
the Customer and the Microsoft Affiliate signing, as of the effective date identified below.
Contract
Document Number.. -
<Choose A reement>
<Choose A reement>
<Choose A reement>
<Choose A reement>
<Choose A reement>
Enterprise Enrollment
X20-10632
<Choose Enrollment/Re
istration>
<Choose Enrollment/Re
istration>
<Choose Enrollment/Re
istration>
<Choose Enrollment/Re
istration>
EA Product Selection Form 0355549.001 PSF
By signing below, Customer and the Microsoft Affiliate agree that both parties (1) have received, read
and understand the above contract documents, including any websites or documents incorporated by
reference and any amendments and (2) agree to be bound by the terms of all such documents.
Name of Entity (must be legal entity name)* City of Costa Mesa
Signature*
Printed First and Last Name* Tom Hatch
Printed Title CEO
Signature Date*
Tax ID
indicates required
ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(Aug2074) Page 1 of
Microsoft Corporation
Signature
Printed First and Last Name
Printed Title
Signature Date
(date Microsoft Affiliate countersigns)
Agreement Effective Date
(may be different than Microsoft's signature date)
Optional 2nd Customer signature or Outsourcer signature (if applicable)
Name of Entity (must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
indicates required field,
•
Name of Entity (must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
indicates required field
If Customer requires physical media, additional contacts, or is reporting multiple previous Enrollments,
include the appropriate form(s) with this signature form.
After this signature form is signed by the Customer, send it and the Contract Documents to Customer's
channel partner or Microsoft account manager, who must submit them to the following address. When
the signature form is fully executed by Microsoft, Customer will receive a confirmation copy.
Microsoft Corporation
Dept. 551, Volume Licensing
6100 Neil Road, Suite 210
Reno, Nevada 89511-1137
USA
Programs ignForm (MSSign)(NA, LatAm)ExBRA, MLI(ENG)(Aug2014) Page 2 oft