The Escrow Company Beneficiary Registration Form

Depositor Company Name *

Software Escrow Agreement Number *

Name of Authorised Representative of Depositor Completing this Form *

Depositor Representative Email Address *

Depositor Contact Telephone Number *

Beneficiary Registered Company Name *

Beneficiary Company Number (if applicable) *

Beneficiary Regsistered Address (Street and Number) *

Beneficiary Registered Address (City) *

Beneficiary Registered Address (Post Code / ZIP Code) *

Beneficiary Country *

Beneficiary Contact Person *

First

Last

Beneficiary Position in Company

Beneficiary Contact Email Address *

Beneficiary Phone Number *

Product Name *

Deposit Materials to be included within this Agreement *

Source Code and documentation
Database/s
Access Credentials

Do you intend to deposit customised Source Code for this Beneficiary?

Would the Beneficiary like verification testing to be performed on the Source Materials?

Note to include specific to this Beneficiary

BY CLICKING ON THE "SUBMIT" BUTTON PROVIDING DIGITAL SIGNATURES AND/OR BY CONTINUING TO ACCESS OUR SERVICE /OR RETURNING YOUR ACCEPTANCE (IF ORDERING VIA ANY OTHER MEANS) YOU AGREE TO ADD THE ABOVE MENTIONED BENEFICIARY TO THE TERMS OF THE ABOVE MENTIONED SOFTWARE ESCROW AGREEMENT NUMBER WHICH WILL BIND YOU TO THOSE CONDITIONS FOR THE REGISTERED BENEFICIARY. IF YOU DO NOT AGREE TO ADDING THE ABOVE MENTIONED BENEFICIARY TO THE TERMS OF THE SOFTWARE ESCROW AGREEMENT, YOU MUST DISCONTINUE THE PROCESS NOW. WHERE YOU ARE USING THIS SERVICE ON BEHALF OF A BUSINESS, YOU WARRANT THAT YOU HAVE THE AUTHORITY TO ENTER THIS CONTRACT AND REGISTER THIS BENEFICIARY ON BEHALF OF YOUR COMPANY (OR OTHER LEGAL ENTITY). Escrow London Limited (UK) T/A The Escrow Company, Escrow London North America Inc DBA The Escrow Company and Escrow London Australia Pty Ltd T/A The Escrow Company APAC operates exclusively on a B2B basis, it does not contract directly to the general public. It does not deal with consumer sales and/or access. By continuing you are confirming that you are not a consumer for the purposes of the Consumer Credit, Consumer Rights, and Sale of Goods legislation and that you are in business and placing an order for the purpose of that business and not for personal use.

Confirmed
Declined

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