Microsoft Covermount

Software Covermount Distribution Application

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* Required Fields

Contact Information

*Name:

*Email:

*Title:

Microsoft Licensed Software Requested*

Internet Explorer® 8

Microsoft Security Essentials

Business Information

*Business Name:

*Address 1:

Address 2:

*City:

State/Province:

*Postal Code/Zip:

*Country:

*Phone:

Fax:

*Website:

Distribution Information

*Magazine Name(s):

*Language Requested:

*Unit Distribution Estimate:

Estimated Date of Distribution:

*Start Date:

*End Date:

CD/DVD Replicator Information

*Redistribution Format (CD/DVD/Other):

*Business Name:

*Business Address:

*Contact Name:

*Contact Email:

Microsoft Regional Contact Information

Name:

Email:

Note for applicant: Make sure you print a copy of this application form and the Agreement for your records.

* Microsoft respects your privacy. Please read our online Privacy Statement. The information you provide will only be used in context of the Microsoft Covermount program. We will not use your information to contact you for any other purpose.