Common use of Name and Contact Information Clause in Contracts

Name and Contact Information. Full legal name of record holder: __________________________________________ Address of record holder: __________________________________________ Social Security Number or Taxpayer identification number of record holder: __________________________________________ Identity of beneficial owner (if different than record holder): __________________________________________ Name of contact person: __________________________________________ Telephone number of contact person: __________________________________________ Fax number of contact person: __________________________________________ E-mail address of contact person: __________________________________________

Name and Contact Information. Full legal name of record holder: __________________________________________ ------------------------ Address of record holder: __________________________________________ ------------------------ ------------------------ Social Security Number or Taxpayer ------------------------ identification number of record holder: __________________________________________ Identity of beneficial owner (if different ------------------------ than record holder): __________________________________________ Name of contact person: __________________________________________ ------------------------ Telephone number of contact person: __________________________________________ ------------------------ Fax number of contact person: __________________________________________ ------------------------ E-mail address of contact person: __________________________________________------------------------

Name and Contact Information. Full legal name of record holder: __________________________________________ -------------------------------- Address of record holder: __________________________________________ -------------------------------- Social Security Number or Taxpayer identification number of record holder: __________________________________________ -------------------------------- Identity of beneficial owner (if different than record holder): __________________________________________ -------------------------------- Name of contact person: __________________________________________ -------------------------------- Telephone number of contact person: __________________________________________ -------------------------------- Fax number of contact person: __________________________________________ -------------------------------- E-mail address of contact person: __________________________________________--------------------------------

Name and Contact Information. Full legal name of record holder: __________________________________________ ---------------------------------- Address of record holder: __________________________________________ ---------------------------------- Social Security Number or Taxpayer identification number of record holder: __________________________________________ ---------------------------------- Identity of beneficial owner (if different than record holder): __________________________________________ ---------------------------------- Name of contact person: __________________________________________ ---------------------------------- Telephone number of contact person: __________________________________________ ---------------------------------- Fax number of contact person: __________________________________________ ---------------------------------- E-mail address of contact person: __________________________________________----------------------------------