Software License and Services Agreement Addendum

							XPSN Change Request                                                                                                        Page 1


                                               ADDENDUM CHANGE REQUEST FORM




Section I.                                                Company Information
Company Name
Tax ID #


Section II.                                      XPSN Administrator Change Request
                                                        Change Administrator
Designated XPSN Administrator (name)
Title
Phone number
Email address

Note: Your designated Administrator can now maintain bank accounts, remittance addresses, and
payment notification e-mail addresses online within the Xign application at http://www.xign.net
By signing this document, you represent and warrant that you have authority for banking and the authority to change the
XPSN Administrator on behalf of the Company listed above.


Signature of person with banking authority (not the person named above)                 Print Name



Title                                                                                   Telephone Number       Date Signed



E-mail

In order to process your request in a timely manner, this form must be signed by someone with banking authority other than
the Designated Xign Administrator.


Please fax Addendum to (925) 469-9447


Instructions and other Frequently Asked Questions (“FAQ’s”) can be found online at http://support.xign.net

For assistance please contact Xign Product Support online: http://support.xign.net/form_web_case.html




                      Xign Internal Use Only
Case Number
Administrator
Company Account Number
Received
Verified
Updated

Change Request Form                                                                                          2005 Xign Corporation
                                                                                                                   Xign Confidential