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Microsoft I Volume Licensing <br />Supplemental Contact Information Form State and Local <br />This, form can be used in cornbinatlon with Agreement and Enroihnpnt/Regl0tation. Howevpr;;a <br />separate form must be submitted for each EnroilinenVRegistration, When mpre than, one is submitted <br />on a signature form, For the purposes of this form, "Entity' can mean the signing Entily, Customer, <br />Enrolled Affiliate, Government Partner, Institution, or other party entering inIci or volume 01 0,nsing <br />program agreement. Primary and Notices contacts in this form will not apply to Enrollments or <br />Registrations. <br />This 'forn applies to, 0 Agreement <br />El EnrollmentiAffiliato Registration Form <br />Insert primary entity name.if more than one Enrollment /Registration Form <br />is submitted <br />Contact information, <br />East, 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 Unity chooses to designate other <br />nte <br />contact types, the &a reynlred fields must he completed for each section. By providing contact <br />Infonriation, entity oonsonts to its use for purposes of administering the Enrollment by Microsoft "end other <br />parties that help Microsoft administer this Enrollment. The personal information provided in eorineollon <br />with this agreement, Will be used and protected according to the prvacy statement .available at <br />j»�s/ /licehsinn.microso .c m. <br />1. Adclitlonal notices contact. <br />This contact receives all notices that are sent from Mlcrosoft. Na online access is granted to this <br />individual. <br />Name of Entity" County of Riverside <br />Contact name *: First Melissa Last Etter <br />Contact emaU* mellssa,etter@rivcoil.org <br />street address* 3, 4501Ath;Street <br />City' Riverside. State* CA Postal code* 92601.3862 <br />Country, us <br />Phone" 951 -965 -7731 Fax <br />This contact is a third party (not the Entity). Warning: This contact receives personally identifiable <br />information of the Entity. <br />2. Software Assurance manager. <br />Tills contact will receive online permissions to manage the Software Assurance benefits under the <br />Enrollment or Registration. <br />Name of Entity* <br />Contact namo*s First Last <br />Contact small, <br />Street address* <br />City* State* Postal code' <br />Country* <br />Phone* Fax <br />SupOontatlln (OFoan(U9)5LG(6NG)(0012010) Page -1 of 3 <br />25C -18 <br />