The Escrow Company Beneficiary Registration Form

Depositor Company Name

Software Escrow Agreement Number

Name of Authorised Representative of Depositor Completing this Form

Depositor Representative Email Address

Depositor Contact Telephone Number

Beneficiary Registered Company Name

Beneficiary Company Number (if applicable)

Beneficiary Registered Address (Street and Number)

Beneficiary Registered Address (City)

Beneficiary Registered Address (Post Code / ZIP Code)

Beneficiary Country

Beneficiary Contact Person

First

Last

Beneficiary Position in Company

Beneficiary Contact Email Address

Beneficiary Phone Number

Product Name

Deposit Materials to be included within this Agreement

Source Code and Documentation
Database(s)
Access Credentials

Product Modules Licensed to the Beneficiary (if relevant)

Do you intend to deposit customised Source Code for this Beneficiary?

Module Name

Module Tag

Repo URL (if relevant)

Module Name

Module Tag

Repo URL (if relevant)

Module Name

Module Tag

Repo URL (if relevant)

Would the Beneficiary like verification testing to be performed on the Source Materials?

TO ABOVE ENTITY).

Note to include specific to this Beneficiary

BY CLICKING ON THE "SUBMIT" BUTTON PROVIDING DIGITAL SIGNATURES AND/OR BY CONTINUING TO ACCESS OUR SERVICE /OR RETURNING YOUR ACCEPTANCE (IF ORDERING VIA ANY OTHER MEANS) YOU AGREE TO ADD THE ABOVE MENTIONED BENEFICIARY TO THE TERMS OF THE ABOVE MENTIONED SOFTWARE ESCROW AGREEMENT NUMBER WHICH WILL BIND YOU TO THOSE CONDITIONS FOR THE REGISTERED BENEFICIARY. IF YOU DO NOT AGREE TO ADDING THE ABOVEMENTIONED BENEFICIARY TO THE TERMS OF THE SOFTWARE ESCROW AGREEMENT, YOU MUST DISCONTINUE THE PROCESS NOW. WHERE YOU ARE USING THIS SERVICE ON BEHALF OF A BUSINESS, YOU WARRANT THAT YOU HAVE THE AUTHORITY TO ENTER THIS CONTRACT AND REGISTER THIS BENEFICIARY ON BEHALF OF YOUR COMPANY (OR OTHER LEGAL ENTITY). Escrow London Limited (UK) T/A The Escrow Company, Escrow London North America Inc DBA The Escrow Company and Escrow London Australia Pty Ltd T/A The Escrow Company APAC operates exclusively on a B2B basis, it does not contract directly to the general public. It does not deal with consumer sales and/or access. By continuing you are confirming that you are not a consumer for the purposes of the Consumer Credit, Consumer Rights, and Sale of Goods legislation and that you are in business and placing an order for the purpose of that business and not for personal use.

Confirmed
Declined

The Escrow Company Beneficiary Registration Form

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