SPLA Contract Form

Use this form to create a new Microsoft SPLA agreement, or to transfer an existing SPLA from another reseller, with TD SYNNEX as your authorized Reseller of Record.

Note: new customers may also be required to set up a customer account with TD SYNNEX under a separate onboarding process.

Agreement Information

Please choose the appropriate type.

Agreement Type *

MPN Number ¹

Existing MBSA Agreement Number ²

Current or Prior SPLA Agreement Number

Payment Terms *

This section is for new SLMS customers located in the United States only.

NET30 Credit Card

Tax exempt

Tax-exempt entities: please email your exemption certificate to us after submitting this form.

Organization Information

The following sections are required.

Company Name *

Street *

City *

State *

Country *

ZIP *

Customer Affiliates ³ * (check one)

Customer Only Customer and all Affiliates included (including future affiliates)

Contacts

Primary Contact

Name *

Address

Phone *

E-mail *

Notices Contact — expand if different from Primary

Name

Address

Phone

E-mail

Customer Profile

Our hosting team is dedicated to helping you compete successfully in the Cloud and Hosting market. This profile helps us provide the personal guidance and expert support you need to capitalize on new opportunities and grow your business.

Company Website *

Type of Service Provider

# of Employees

¹ To be eligible for the Microsoft SPLA program, you should be enrolled in the Microsoft Partner Network. If you are currently enrolled but do not know your MPN, contact Microsoft at 800-765-7768 or mpnsolve@microsoft.com.

² Organizations can use one MBSA to support multiple licensing program types (i.e. EA, Select, etc.). If you have an existing MBSA, you may use it even if this is a new SPLA Agreement.

³ “Affiliate” means any legal entity that a party owns, that owns a party, or that is under common ownership with a party. “Ownership” means, for purposes of this definition, control of more than a 50% interest in an entity.