Microsoft Select Agreement Customers
Microsoft Select Agreement Customers
Hosting License Verification Form
|Customer Select Agreement number | |Customer Microsoft Business Agreement| |
| | |number | |
This Microsoft Hosting License Verification Form to be used to report licenses being hosted by a service provider.
|Customer |
|Name of Entity | |Contact Name |
|Street Address | |Contact E-mail Address | |
| | | | |
|City | |State/Province |Phone | |
|Country | |Postal code |Fax | |
|Customer Signature | |Hosting Commencement Date (MM/YY) | |
|Hosting Service Provider |
|Name of Entity | |Contact Name |
| | | |
|Street Address | |Contact E-mail Address | |
| | | | |
|City | |State/Province |Phone | |
|Country | |Postal code |Fax | |
| | | |Microsoft Account Mgr Name | |
|Please complete this section to verify the licenses being hosted by the above hosting service provider |
|Microsoft Software Products |Number of Licenses or Seats |
| | |
| | |
| | |
| | |
| | |
| | |
Return completed form to one of the following:
Mailing address: email: Fax:
Service Provider License Agreement spla@ 1-425-706-7329
Microsoft Corporation Attn: Service Provider License Agreement
One Microsoft Way
Redmond, WA 98052-6399
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