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Customer Information
Licensee Name:	*
Customer #
	Licensee is in care of Third Party

Product Information
Select product(s):	Phoenix Preference *
Version:	*

On this event date (date) * (Please select one) *
We are transferring (moving) the “Products” on (date)
We have or are scheduled to upgrade the CPU affecting the “Products” currently running on (CPU)
Our current EXPID expires and need a new Standard Code (Coterminous to Annual Maintenance Date)
We are going to be Testing the “Products” (10 Business Days Only) from -
We are performing a Disaster Recovery Test (5 Business Days Only) from -
We are going to a new release and are requesting an EXPID for version

Current CPU
Make	*
Type	*
Model	*
Serial	*

Located
Street Address:	*
Additional Address:
City/Town:	*
State/Province:	*
Zip/Postal Code:	*
Country:	*

New CPU
Make
Type
Model
Serial

Located	Same as above
Street Address:
Additional Address:
City/Town:
State/Province:
Zip/Postal Code:
Country:


Requestor’s Name:	*
Job Function:	*
Company:	*
Phone:	*
Fax:
Business Email:	*

Additional Notes :

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