Any information transmitted to and from the requester through this emailmeform are confidential and intended solely for the request of software authorization. The requester should make his/her given information secured and protected. If you have sent this emailmeform in error, this third party agent accepts no liability for any loss or damage caused by your unsecured and unprotected information.

I certify that information contained in this application is accurate. I understand that false information may lead to my request disregarded. I authorize the verification of any or all information listed above.