Microsoft Signature Form

ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(May2020) 
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Document X20-12883 
 
Program Signature Form 
MBA/MBSA number 
 
 
5-0000008615511 
Agreement number 
8505135 
 
 
Note:  Enter the applicable active numbers associated with the documents below.  Microsoft requires the 
associated active number be indicated here, or listed below as new. 
 
For the purposes of this form, “Customer” can mean the signing entity, Enrolled Affiliate, 
Government Partner, Institution, or other party entering into a volume licensing program agreement. 
This signature form and all contract documents identified in the table below are entered into between 
the Customer and the Microsoft Affiliate signing, as of the effective date identified below. 
Contract Document 
Number or Code 
Enterprise Enrollment (Indirect) 
X20-10635 
Sub250 Form 
W29 
Product Selection Form 
1195573.003_PSF 
Enterprise Amendment 
M97 (NEW) 
By signing below, Customer and the Microsoft Affiliate agree that both parties (1) have received, read 
and understand the above contract documents, including any websites or documents incorporated by 
reference and any amendments and (2) agree to be bound by the terms of all such documents. 
Customer 
Name of Entity (must be legal entity name)* City of El Mirage 
Signature*  
Printed First and Last Name*  
Printed Title  
Signature Date*  
Tax ID  
* indicates required field 
Microsoft Affiliate 
Microsoft Corporation 
Signature   
Printed First and Last Name  
Printed Title  
Signature Date  
(date Microsoft Affiliate countersigns) 
Agreement Effective Date  
(may be different than Microsoft’s signature date)

ProgramSignForm(MSSign)(NA,LatAm)ExBRA,MLI(ENG)(May2020) 
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Document X20-12883 
 
Optional 2nd Customer signature or Outsourcer signature (if applicable) 
Customer 
Name of Entity (must be legal entity name)*  
Signature*  
Printed First and Last Name*  
Printed Title  
Signature Date*  
* indicates required field 
Outsourcer 
Name of Entity (must be legal entity name)*  
Signature*  
Printed First and Last Name*  
Printed Title  
Signature Date*  
* indicates required field 
If Customer requires additional contacts or is reporting multiple previous Enrollments, include the 
appropriate form(s) with this signature form. 
After this signature form is signed by the Customer, send it and the Contract Documents to Customer’s 
channel partner or Microsoft account manager, who must submit them to the following address.  When 
the signature form is fully executed by Microsoft, Customer will receive a confirmation copy. 
Microsoft Corporation 
Dept. 551, Volume Licensing 
6880 Sierra Center Parkway 
Reno, Nevada  89511 
USA