exv10w26








    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.



 




    EXHIBIT 10.26



 




    ADDENDUM
    ELEVEN

    TO THE

    SOFTWARE LICENSE AGREEMENT

    BETWEEN

    DELL PRODUCTS, LP

    AND

    COMMVAULT SYSTEMS, INC.



 



    This Addendum Eleven (“Addendum”) to the Software
    License Agreement dated December 17, 2003 (the
    “Agreement”) is entered into by and between Dell
    Global BV (Singapore Branch) incorporated in The Netherlands
    with limited liability, operating through its Singapore branch
    on behalf of itself and the subsidiaries and affiliates of Dell
    Inc. (hereinafter “Dell”), and CommVault Systems,
    Inc., (hereinafter “CommVault”), a Delaware
    corporation having a principal place of business at 2 Crescent
    Place, Oceanport, New Jersey 07757 (hereinafter
    “Licensor”) and is effective as of the 9th day of
    April, 2009 (the “Effective Date”).



 




    RECITALS
    



 



    WHEREAS, CommVault and Dell entered into the Agreement through
    which CommVault granted Dell various rights to distribute
    certain CommVault software products;



 



    WHEREAS, CommVault and Dell wish to amend the Agreement and
    replace all Pricing Supplements, as set forth in
    Addendum #10 dated October 1, 2008 and also wish to
    modify the rebate and MDF provisions set forth in
    Addendum #9 dated September 1, 2008.



 



    NOW THEREFORE, in consideration of the mutual covenants and
    promises set forth herein and for other good and valuable
    consideration, the receipt of which both parties hereby
    acknowledge, Dell and CommVault agree as follows:



 



    The rebate and MDF terms introduced in Addendum #9, and the
    pricing terms introduced in Addendum #10, shall be deleted
    in their entirety and replaced with the following:



 



    1.  Quarterly Rebate.



 



    For Licensed Products distributed by Dell (with the exception of
    [***] for which rebates provided for herein shall not apply),
    Dell shall earn a rebate equal to [***] (“Rebate
    Percentage”) of the aggregate quarterly royalties paid by
    Dell, as reported on the royalty report. For the purposes of
    clarification, the royalties due per copy of the Licensed
    Product shipped are as shown in the “Total” column
    (column E) in Exhibit A attached hereto. Dell shall
    have the right to deduct the aggregate quarterly rebate amount
    due to Dell from Dell’s quarterly royalty payment to
    CommVault. For clarification, Volume Purchase Agreement
    (“VPA”) and Enterprise License Agreement
    (“ELA”) transactions are excluded from the definition
    of Licensed Products for the purposes of the Rebate Percentage
    only.



 



    2.  Quarterly MDF



 



    For all Licensed Products distributed by Dell, Dell shall earn
    MDF equal to [***] (“MDF Percentage”) of the aggregate
    quarterly software royalties paid by Dell, (column C of
    Exhibit A) as reported on the royalty report. For
    clarification, VPA and ELA transactions are excluded from the
    definition of Licensed Products for the purposes of the MDF
    Percentage only.


 


			
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    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.


 



    2.1  Terms and conditions of MDF



 



    i. Licensor will provide the MDF in the form of
    reimbursement for specific, identifiable and mutually agreed
    marketing expenses incurred by Dell
    and/or
    Licensor.



 



    ii. The parties shall meet quarterly to determine the
    subsequent period marketing activities to which the Quarterly
    MDF shall be applied (“Reimbursable Activities”). The
    MDF may only be applied to Reimbursable Activities approved by
    Licensor.



 



    iii. Dell will provide backup documentation supporting its
    payment requests for Reimbursable Activities. Dell payment
    requests shall be consistent with the Proof of Compliance form,
    attached as Exhibit B to this Addendum. Licensor may only
    request backup documentation in accordance with the Proof of
    Compliance form in Exhibit B and relative to Dell’s
    current or past immediate quarter’s marketing activities.
    Licensor reserves the right to deny any claims where required
    documentation for reimbursement is not available or incomplete.
    Licensor shall provide email acceptance from a designated
    authorized person of Proof of Compliance forms submitted by
    Dell. Upon acceptance, the Proof of Compliance form shall
    constitute Dell’s invoice to Licensor, and the MDF
    reimbursement shall be payable to Dell thirty (30) days
    following the date the Proof of Compliance was originally
    submitted by Dell. In the event expenses are incurred by
    Licensor, which are to be reimbursed from the MDF fund, the
    above process shall apply with the parties’ roles reversed.



 



    iv. The MDF is provided at the sole discretion of Licensor.
    Licensor reserves the right to cancel the MDF with ninety
    (90) days notice to Dell. Licensor reserves the right, upon
    request, to audit the reimbursement process
    and/or the
    expenses submitted for reimbursement.



 



    3.  Any and all Pricing Supplements to the Agreement
    are hereby replaced in their entirety with the attached
    Exhibit A to this Addendum. Dell’s cost for the
    products and skus listed in Exhibit A (“OEM
    Cost”) shall be a minimum of [***] than the cost at which
    CommVault makes available the equivalent or comparable products
    and skus listed on the Dell Direct Supplier Agreement with
    CommVault, dated August 2, 2008, as such may be amended
    from time to time by the parties (“S&P Cost”),
    such that if at any time the difference between the S&P
    Cost and the OEM Cost is less than [***], the OEM Cost shall be
    immediately lowered to maintain this requirement.



 



    No other changes or modification are intended by this Addendum.
    All other terms and conditions of the Agreement are in effect.



 



    Any capitalized terms defined in this Addendum are specific to
    this Addendum only, and do not modify or change the meaning set
    forth in the Agreement. Unless expressly defined in this
    Addendum, the capitalized terms in this Addendum are as defined
    in the Agreement. The Agreement shall remain in full force and
    effect except as supplemented and amended herein.


 


			
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    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.


 



    SIGNATURE PAGE



 



    IN WITNESS WHEREOF, the parties have executed this Addendum by
    their duly authorized representatives effective as of the date
    first set forth above.



 



    SIGNATURE PAGE



 


	 	 	 
	
    COMMVAULT SYSTEMS,
    INC.
	
 
	
    DELL GLOBAL BV (SINGAPORE
    BRANCH)

	 

	

    By: /s/ David R. West

    


    Name: David West

    Title: VP, Marketing & Business Devel.

    



	
 
	

    By: /s/  Richard A. Conrad

    


    Name: Richard A. Conrad

    Title: Vice President, Worldwide Procurement, SDC




	
 
	
 
	
 

	

    Date:  April 21, 2009


	
 
	
    Date:  April 21, 2009








 


			
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    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.


 




    Exhibit A

    Pricing
    Supplement



 


	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
    A
	
 
	
    B
	
 
	
    C
	
 
	
 
	
    D
	
 
	
 
	
    E
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Annual

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Maintenance

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    protection

    
	
 
	
 
	
 
	
 

	
    DELL

    
	
 
	
 
	
 
	
 
	
 
	
 
	
    includes L2 & L3

    
	
 
	
 
	
 
	
 

	

    SKU


	
 
	

    SKU Description


	
 
	
    Dell SW Cost
	
 
	
 
	
    Support
	
 
	
 
	
    Total
	
 

	 

	

    SKU1


	
 
	
    CommVault CommServe (Master Server)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU2


	
 
	
    CommVault Media Server (incl client agent)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU3


	
 
	
    CommVault iSCSI Media Server (incl client agent)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU4


	
 
	
    CommVault LAN Drive Pack
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU5


	
 
	
    CommVault SAN Drive Pack
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU6


	
 
	
    CommVault Client Agent (File System iDA) or AD Agent
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU7


	
 
	
    CommVault Application Agent for Windows (Exchange, SQL, SPPS,
    MySQL, OCS, Oracle, Notes, GroupWise)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU8


	
 
	
    CommVault Application Agent for Unix (Oracle, SAP, DB2,
    Informix, Sybase)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU9


	
 
	
    CommVault Standard Disk Option 1 TB
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU10


	
 
	
    CommVault Deduplication to Disk (Advanced Disk Option) 1 TB
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU11


	
 
	
    CommVault Deduplication to Disk & Tape (Consolidated
    Data Storage Option) 1 TB
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU12


	
 
	
    CommVault Upgrade to Deduplication 1TB (STD to Advanced or
    Advanced to CDSO)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU13


	
 
	
    CommVault Gridstor for Master Server
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU14


	
 
	
    CommVault Gridstor for Media Server
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU15


	
 
	
    CommVault Universal Client Access License (CAL)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU16


	
 
	
    CommVault Content Director CAL Upgrade
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU17


	
 
	
    CommVault Workstation Backup Agents (25 pack)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU18


	
 
	
    CommVault Client Agent for VM Guest OS or Virtual Node or SRM
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU19


	
 
	
    CommVault Virtual Infrastructure Host
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU20


	
 
	
    CommVault Data Replicator (CDR)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU21


	
 
	
    CommVault CommCell Encryption Enabler
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU22


	
 
	
    CommVault Secondary Copy Encryption (per Media Server)
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU23


	
 
	
    CommVault Snap Backup Enabler or SRM Storage Server
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU24


	
 
	
    CommVault Offline Mining Tool Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU25


	
 
	
    CommVault Exchange Mining Tool
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU26


	
 
	
    CommVault Content Indexing — Online Data
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU27


	
 
	
    CommVault Content Indexing — Offline Data
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU28


	
 
	
    CommVault Content Indexing — Server Node
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 



 


			
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    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.


 


	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
    A
	
 
	
    B
	
 
	
    C
	
 
	
 
	
    D
	
 
	
 
	
    E
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Annual

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Maintenance

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    protection

    
	
 
	
 
	
 
	
 

	
    DELL

    
	
 
	
 
	
 
	
 
	
 
	
 
	
    includes L2 & L3

    
	
 
	
 
	
 
	
 

	

    SKU


	
 
	

    SKU Description


	
 
	
    Dell SW Cost
	
 
	
 
	
    Support
	
 
	
 
	
    Total
	
 

	 

	

    SKU29


	
 
	
    CommVault Content Indexing — Admin / Web Server
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU30


	
 
	
    Dell Maintenance — $1
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU31


	
 
	
    Dell Maintenance — $10
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU32


	
 
	
    Dell Maintenance — $100
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU33


	
 
	
    Dell Maintenance — $1000
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU34


	
 
	
    Dell Software — $1 SKU
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU35


	
 
	
    Dell Software — $10 SKU
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU36


	
 
	
    Dell Software — $100 SKU
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU37


	
 
	
    Dell Software — $1000 SKU
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU38


	
 
	
    Dell Software — $10000 SKU
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU39


	
 
	
    CommVault Exchange MB or File Archiving Bundle — 150
    CALS
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU40


	
 
	
    CommVault Exchange Compliance or SharePoint or NAS Archiving
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU41


	
 
	
    CommVault Simpana 5 Server Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU42


	
 
	
    CommVault Simpana 5 Server Bundle w/Deduplication
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU43


	
 
	
    Remote Office Dedupe Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU44


	
 
	
    CommVault Snapshot Client Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    SKU45


	
 
	
    CommVault 5 Server Bundle — Dell Channel
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 









 


	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Annual

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Maintenance

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    protection

    
	
 
	
 
	
 
	
 

	
    DELL

    
	
 
	
 
	
 
	
 
	
 
	
 
	
    includes L2 & L3

    
	
 
	
 
	
 
	
 

	

    SKU


	
 
	

    SKU Description


	
 
	
    Dell SW Cost
	
 
	
 
	
    Support
	
 
	
 
	
    Total
	
 

	 

	

    ESKU1


	
 
	
    Galaxy Express File Server Edition:
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    ESKU2


	
 
	
    CommVault Express
    E-mail &
    Database Server Edition
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    ESKU3


	
 
	
    CommVault Express Virtual Server Edition
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    ESKU4


	
 
	
    CommVault Express Application Agent (incl Client
    Agent) — For Express only
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    ESKU5


	
 
	
    CommVault Express Client Agent — For Express only
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    ESKU6


	
 
	
    Upgrade key to unlock Galaxy Express to Galaxy
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 









 


	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Annual

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    Maintenance

    
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 
	
    protection

    
	
 
	
 
	
 
	
 

	
    DELL

    
	
 
	
 
	
 
	
 
	
 
	
 
	
    includes L2 & L3

    
	
 
	
 
	
 
	
 

	

    SKU


	
 
	

    SKU Description


	
 
	
    Dell SW Cost
	
 
	
 
	
    Support
	
 
	
 
	
    Total
	
 

	 

	

    MSKU1


	
 
	
    PowerVault DL2000 — Standard Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    MSKU2


	
 
	
    PowerVault DL2000 — Advanced Bundle
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 

	

    MSKU3


	
 
	
    3TB Upgrade from Disk Dedupe to Disk + Tape Dedupe
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 
	
 
	
    $
	
    [***]
	
 








 


			
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    CONFIDENTIAL
    TREATMENT



 




    [***]
    Indicates that text has been omitted which is the subject of a
    confidential treatment request. This text has been separately
    filed with the SEC.


 




    EXHIBIT B

    



 




    MDF PROOF
    OF COMPLIANCE FORM



 




	 	 	 	 	 	 
	

    Fiscal Year:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Fiscal Quarter:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Segment:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Program Name:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Program Description:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Program Owner:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 









 


	 	 	 	 	 	 
	

    Program Objective:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Program Deliverables:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Partner Payment Details:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Proof of Compliance

    (POC) Details:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    POC Owner:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 









 






    Contact
    Information:



 


	 	 	 	 	 	 	 
	

    Name:


	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Participant Address:


	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    City


	
 
	
 
	
    State
	
 
	
 
	
    Zip

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Marketing Contact:


	
 
	
 
	
 
	
 
	
 
	
    Phone

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Marketing Contact Title:


	
 
	
 
	
 
	
 
	
 
	
    Fax

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
    Email

	
 
	
 
	
 
	
 
	
 
	
 
	
 









 






    Bill To
    Information:



 


	 	 	 	 	 	 	 
	

    Name:


	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Bill to Address


	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    City


	
 
	
 
	
    State
	
 
	
 
	
    Zip

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Accounting Contact Accounts Payable


	
 
	
 
	
 
	
 
	
 
	
    Bill to Phone

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 
	
    Bill to Fax

	
 
	
 
	
 
	
 
	
 
	
 
	
 

	

    Is PO # required for
    invoicing?  YES     NO     If
    yes, please provide PO#:



	
 
	
 
	
 
	
 
	
 
	
 
	
 









 




	 	 	 	 	 	 
	

    Price:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Program Name:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 

	

    Dell Contact:


	
 
	
 
	
 
	
 
	
 

	
 
	
 
	
 
	
 
	
 
	
 








 


			
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