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Supplemental Contact Information Form State and Local
This form can be used in combination with Agreement and Enrollment/Registration. However, a separate form must be submitted for each Enrollment/Registration, when more than one is submitted on a signature form. For the purposes of this form, “Entity” can mean the signing Entity, Customer, Enrolled Affiliate, Government Partner, Institution, or other party entering into a Volume Licensing program agreement. Primary and Notices contacts in this form will not apply to Enrollments or Registrations.
This form applies to: Agreement
Enrollment/Affiliate Registration Form
Insert primary entity name if more than one Enrollment/Registration Form is submitted
Contact information.
Each party will notify the other in writing if any of the information in the following contact information page(s) changes. The asterisks (*) indicate required fields; if the Entity chooses to designate other contact types, the same required fields must be completed for each section. By providing contact information, entity consents to its use for purposes of administering the Enrollment by Microsoft and other parties that help Microsoft administer this Enrollment. The personal information provided in connection with this agreement will be used and protected according to the privacy statement available at https://licensing.microsoft.com.
1. Additional notices contact.
This contact receives all notices that are sent from Microsoft. No online access is granted to this individual.
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*
Phone* Fax
This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
2. Software Assurance manager.
This contact will receive online permissions to manage the Software Assurance benefits under the Enrollment or Registration.
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*
Phone* Fax
Legal Review
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This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
3. Subscriptions manager.
This contact will assign MSDN, Expression, and TechNet Plus subscription licenses to the individual subscribers under this Enrollment or Registration. Assignment of the subscription licenses is necessary for access to any of the online benefits, such as subscription downloads. This contact will also manage any complimentary or additional media purchases related to these subscriptions.
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*
Phone* Fax
This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
4. Online Services manager.
This contact will be provided online permissions to manage the Online Services ordered under the Enrollment or Registration.
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*
Phone* Fax
This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
5. Customer Support Manager (CSM):
This person is designated as the Customer Support Manager (CSM) for support-related activities.
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*
Phone* Fax
This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
6. Primary contact information:
An individual from inside the organization must serve as the primary contact. This contact receives online administrator permissions and may grant online access to others. This contact also receives all notices unless Microsoft is provided written notice of a change.
Name of Entity*
Contact name*: First Last
Legal Review
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Contact email*
Street address*
City* State* Postal code*
Country*:
Phone* Fax
7. Notices contact and online administrator information:
This individual receives online administrator permissions and may grant online access to others. This contact also receives all notices.
Same as primary contact
Name of Entity*
Contact name*: First Last
Contact email*
Street address*
City* State* Postal code*
Country*:
Phone* Fax
This contact is a third party (not the Entity). Warning: This contact receives personally identifiable information of the Entity.
Legal Review