Microsoft Enterprise Agreement Customers



Microsoft Enterprise Agreement Customers

Hosting License Verification Form

|Customer Enterprise 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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