Support Services Authorized List (Appendix E)

Primary Technical Contact, Named Callers and Purge Approvers Form

To enable us to keep our records up to date please complete the attached details and either fax: to (610) 382-5111 or email to: Support@ActiveWorx.com

Company Name: –        __________________________________________________________________

Company Address: –     __________________________________________________________________

__________________________________________________________________

Contract Number: –      __________________________________________________________________

I nominate the following people to contact ActiveWorx on behalf of my company and understand that I should notify ActiveWorx of any changes by updating and returning this form.

Signed: – ___________________________     Date: – ________________________

Primary Technical Contact	Title	Phone Number	Email
Authorized Personnel to Call for Support	Title	Phone Number	Email
Personnel Authorized to Request Document Purge	Title	Phone Number	Email

*Additional Authorized Personnel may be added upon request. Additional charges may apply.