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mir,' osoft Volume LIC'('_IlSII') <br />Supplemental Contact Information Form <br />This form can be used In comblilatloh with M136A, Agreement, and Enrollmont Rogistralion, <br />However, a separate form must be submiled for each onrollmentfroglstration, when more than one is <br />submitted on a signature form. For the purposes of this form, 'entity' can moan ilia signing entity, <br />Cuslorner, Enrolled Affiliate, Govanvmenti Porinor, Institution, or other party entering Into a volume <br />licensing program agreement. Primary and Notices contacts In this form will riot apply to enrollments <br />or registrations. <br />This form Applies to: 0 PADSA <br />Agreement <br />I <br />E] gnrollmentlAlfiliale Registration Form <br />Insert primary entity name It more then one Enm6monl/Ragislrolton <br />form Is subml(to(I <br />Contact information, <br />Each party will nollfy the other in writing I( tiny of Ilia Information In the following contact information <br />pages) changes. 1-11e asterlsl(s (') Indicate required flaldsl if the entity chooses to designate other <br />contact types, the some required fields mull be cMpleted for each section, By providing contact <br />inforinailon, 4ntily consents to Its usa for putposes of administering the Enrollment by Iv)icrosoff and 011ie( <br />penes that help 101cro3on administer this Cnrollment. The personal Information provided In connection <br />with this agreement will be used and protected acwrsling to Iho privacy statomanf Mf 3bla al <br />lit tns:ltlf censi n_�).jn icrosofhcom. <br />9. Additional notices contact, <br />This contact receives all notices that are sent from Microsoft. No online access is granted to this <br />Individual, <br />Name of entity' County of Riverside <br />Contact name: First Regina Last Fundedludt <br />Contact antall address' RFundoiburl(lrarlveo.org <br />$(real address' 345t1141h Street, 4u1 Floor <br />city, Riverside Statolprovhace, California (Postal code" 0250-1-3861 <br />Country" USA <br />PhOne' g51-g55-22ti5 Fax i <br />D 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 />This contort. will receive online permissions to mannge the Software Assurance benefits under lira <br />Enrollment or Registration. <br />Name of entity' County of Riverside <br />Contact name': First Regina Last Funderburk <br />Contact ernalt ncldreW RFunderbudt[cnilvco.org <br />Street address" 3460 14th Street, 41h Floor, <br />City' Riverside StatorProvince' California Postal code' 512501-3881 <br />i <br />I <br />sanCnnu,on�ant-o„�,tuan.lalc,atrrlc7(pr,12411) I'a9c 141 :1 <br />