Change of Distributor

(To be used only when Distributor is not named on Customer’s volume licensing contract.)

This form is to be used for a change of Distributor when the Distributor information is not physically named or listed on Customer’s licensing program documents. If the Distributor is named on Customer’s licensing program documents, please use the Change of Distributor form which requires Customer to acknowledge the change.

By accurately completing and submitting to Microsoft this Change of Distributor (individually, the “Distributor”) form, the newly appointed Distributor is providing to Microsoft written notification of the change. Microsoft will update its records and systems according to the information the newly appointed Distributor provides. The newly appointed Distributor will receive an email of Microsoft’s acceptance of the form.

By signing below, the newly appointed Distributor represents and agrees that:

·  The newly appointed Distributor has confirmed that it is from a list of authorized Distributors that offer Microsoft Volume Licensing Products.

·  The change in Distributor will take effect 30 days from the date this form is signed by the newly appointed Distributor. This form must be received by Microsoft within 10 calendar days of the signature date.

·  The newly appointed Distributor or its Reseller must notify Microsoft and the previous Distributor in writing. This form constitutes notification to Microsoft, and is the only formal notification accepted. The newly appointed Distributor may notify the previous Distributor by its own means, but such notification must be sent on or before the date the newly appointed Distributor signs this form.

·  All amounts due before the effective date of the change will be paid to the previous Distributor. All amounts due on or after the effective date of the change will be paid to the newly appointed Distributor.

·  The newly appointed Distributor and its Reseller are responsible for working out all other arrangements related to this change with the previous Distributor, and the newly appointed Distributor and its Reseller are responsible for ensuring all obligations to the previous Distributor are met.

·  A delay may occur in recording this change, from receipt of this notice to the date of the change, and the newly appointed Distributor and its Reseller agree to hold Microsoft harmless and release Microsoft from any disputes arising out of any payment(s) made, or any credit issued, to an incorrect Distributor as a result of this change.


1. Customer Name.

Customer Name*:

2. What this change applies to.

Complete all that apply:

ChangeOfDist(NoCustSig)(WW)(ENG)(Oct2009) / Page 3 of 3
Agreement/Enrollment/Public Customer Number
Agreement/Enrollment/Public Customer Number
Agreement/Enrollment/Public Customer Number
Agreement/Enrollment/Public Customer Number
Agreement/Enrollment/Public Customer Number
Agreement/Enrollment/Public Customer Number

3. Previous Distributor Information.

Identify the previous Distributor:

Distributor name*:

Street address:

City: State/Province: Postal code:

Country*:

Contact name: Last , First

Phone:

Fax:

E-mail address:

4. Newly appointed Distributor information.

Identify the newly appointed Distributor:

Distributor name*:

PCN number*:

Street address*:

City*: State/Province: Postal code*:

Country*:

Contact name*: Last , First

Phone *:

Fax:

E-mail address*:

The undersigned confirms that the Distributor information is correct.
Distributor name*
Signature*
Printed name*
Printed title*
Date*
5. Current Reseller.

Reseller name*:

Street address*:

City*: State/Province: Postal code*:

Country*:

6. Media ship-to information.

Complete if media is shipped to Distributor:

Distributor name*:

Street address (no P.O. boxes accepted)*:

City*: State/Province: Postal code*:

Country*:

Contact name*: Last , First

Contact phone *:

Contact fax:

Contact e-mail address*:

* indicates required information

7. To be completed by Customer.

Reason(s) for submitting this change of Distributor request:

Previous Distributor no longer Microsoft authorized

Additional services provided by newly appointed Distributor

Satisfaction – overall poor performance

Prefer licensing services options through multiple Distributors

Other (if Other is checked, must provide a reason)

Additional comments and concerns:

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