Request for Change of Name on a Microsoft Dynamics License Form
The following license will be changed to reflect that the licenseehas changed their name: Microsoft Dynamics NAV serial no.: Microsoft Dynamics AX serial no.: Microsoft Dynamics GP account no.: Microsoft Dynamics SL account no.: MicrosoftDynamics CRM account no: Microsoft Dynamics Retail Management System account no: Microsoft Small Business Financials account no: The license is presently registered underthe name of: Present name of Licensee: Address: Postal Code, City & Country: Phone no.: Company Registration no.: The license name is to be changed to: Future name ofLicensee: Signature by Licensee Inversiones GA Ltda. ________________ Fancymusic Luis Thayer Ojeda 576, Providencia 00000 5628286600
Print name of Licensee Dateof Signature
Juan Carlos Valenzuela Agosto 17, 2010
* Note that you must be listed as a professional under your company’s account in order to sign this form. If youare not listed please work with your company’s administrator to become a listed professional. The below-mentioned documentation for the change of name shall be enclosed: Reason for request for change of name. Legal documentation of the name change being processed and finalized.
Microsoft Dynamics Partner Contact information: Name ofMicrosoft Dynamics Partner: Address: Postal Code, City & Country: Mekano Pedro de Valdivia 555, piso 9, Providencia 00000
License Transfer Policy and GuidelinesPhone no.: Contact Person: 5623724400 Waldo Garrido
Please return this completed form to your local Regional Operations Center via your local partner.