EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

1

1. CUSTOMER PORTAL ADMINISTRATOR(S)

The Customer authorizes the following person(s) to act as its Customer Portal (CP)

Administrator(s). The Customer shall notify BPA of any changes to the CP Administrator’s

information provided below.

Primary CP Administrator

Information:

Secondary CP Administrator

Information:

Name:

Name:

Title:

Title:

Email:

Email:

Address:

Address:

Phone:

Phone:

CP Administrators are given full access to the entire CP Site.

CP Admin Permission Expanded CP User Permissions

Standard Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

X X X X

2. CP USER(S) PERMISSIONS

There are two types of CP User permissions available; Standard or Energy Efficiency (EE)

only.

Standard:

Allows the CP User to view the following: bills, meter point info and meter

diagrams, load and resources forecasts, contracts, EE reimbursement activity

and all subsidiary site(s) listed on Exhibit B.

EE Only:

Allows the CP User to view only EE information and submit EE invoices on

behalf of the customer.

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

2

Additionally, three more expanded CP User permissions can be added to the standard

permission to give the CP User additional capabilities. They include Submit EE

Invoice(s), Submit Load Forecast(s) and View Fiber/Wireless Contract(s).

Submit EE Invoice(s):

Can be added to the Standard permission to also allow the CP User to submit EE

invoice(s).

Submit Load Forecast(s):

Can be added to the Standard permission to also allow the CP User to submit

load and resource forecast(s).

View Fiber/Wireless Contract(s):

Can be added to the Standard permission to also allow the CP User to view fiber

and wireless contract(s).

3. CP USER(S)

The CP Administrator(s) authorizes the following employees, agents, and assignees as CP

User(s) to access and use the Customer’s CP on the Customer’s behalf. CP User(s) listed

below will also have access to any subsidiary sites listed in the Customer’s Exhibit B,

Customer Subsidiaries.

The CP Administrator(s) shall notify BPA of any changes to the CP User’s information. If

six or less CP User(s) will be granted access, Exhibit A (Short Form) can also be used.

Permissions must be selected for each CP User(s).

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

3

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

4

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

5

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

6

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

7

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

8

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

9

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

CP User Information: Add Remove Existing

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE Only Submit EE

Invoice(s)

View Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

10

4. AUTHORIZED THIRD PARTY USER(S)

The CP Administrator(s) authorizes the following entities to access its data and/or submit

data on the Customer’s behalf via the CP. Third party entities may not sub-delegate this

permission. Third Party User(s) listed below will also have access to any subsidiary sites

listed in the Customer’s Exhibit B, Customer Subsidiaries.

If five or less Third Party User(s) will be granted access, Exhibit A (Short Form) can also be

used. Permissions must be selected for each Third Party User(s).

There are three types of Authorized Third Party User(s) permissions available; Standard,

EE only or Third Party Meter Data MDMR2.

Standard:

Allows the user to view the following: bills, meter point info and meter diagrams,

load and resources forecasts, contracts, EE reimbursement activity and all

subsidiary site(s) listed on Exhibit B.

EE Only:

Allows the user to view only EE information and submit EE invoices on behalf of the

customer.

Third Party Meter Data MDMR2:

Allows the user to view only specific meters and detailed meter information. Access

to Third Party Meter Data requires an additional form to be filled out. Find MDMR2

Meter Data Access Request form and instructions at https://customerportal.bpa.gov.

Additionally, three more expanded Third Party User(s) permissions can be added to the

standard permission to give the user additional capabilities. They include Submit EE

Invoice(s), Submit Load Forecast(s) and View Fiber/Wireless Contract(s).

Submit EE Invoice(s):

Can be added to the Standard permission to also allow the user to submit EE

invoice(s).

Submit Load Forecast(s):

Can be added to the Standard permission to also allow the user to submit load and

resource forecast(s).

View Fiber/Wireless Contract(s):

Can be added to the Standard permission to also allow the user to view fiber and

wireless contract(s).

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

11

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

12

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

13

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

14

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

15

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

16

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

EXHIBIT A (LONG FORM), REVISION _____ (Customer Submitted)

AGREEMENT (Contract Number) ___________________

CUSTOMER PORTAL ADMINISTRATOR(S), USER(S) AND AUTHORIZED THIRD

PARTY USER(S)

NOTE: ALL INFORMATION FOR SECTION 1 AND AT LEAST ONE USER IN SECTION 3

(INCLUDING PERMISSIONS) MUST BE COMPLETED BY THE CUSTOMER BEFORE

SUBMITTING TO BPA.

17

3rd Party User Information: Add Remove Existing

Entity Name:

Name:

Title:

Email:

Address:

Phone:

Select One Only Expanded CP User Permissions

(added to Standard only)

Standard EE

Only

3rd Party Meter Data

MDMR2 (additional form needed)

Submit EE

Invoice(s)

View

Fiber/Wireless

Contract(s)

Submit Load

Forecast(s)

5. EXHIBIT REVISIONS

If updates to this exhibit are necessary to accurately reflect the authorized user(s) or their

contact information contained in this exhibit, the Customer or the CP Administrator(s)

shall provide a revised Exhibit A to BPA. This revised Exhibit A shall be effective upon

receipt by BPA.

Customer Legal Name:

Name (Print/Type):

Signature:

Title:

Date:

Customer Legal Name: Date: Group1: OffGroup2: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffGroup3: OffGroup4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffGroup5: OffGroup6: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffGroup7: OffGroup8: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffGroup9: OffGroup10: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffGroup11: OffGroup12: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffGroup13: OffGroup14: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffGroup15: OffGroup16: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffGroup17: OffGroup18: OffCheck Box26: OffCheck Box27: OffCheck Box28: OffGroup19: OffGroup20: OffCheck Box29: OffCheck Box30: OffCheck Box31: OffGroup21: OffGroup22: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffGroup23: OffGroup24: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffGroup25: OffGroup26: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffGroup27: OffGroup28: OffCheck Box41: OffCheck Box42: OffCheck Box43: OffGroup29: OffGroup30: OffCheck Box44: OffCheck Box45: OffCheck Box46: OffGroup31: OffGroup32: OffCheck Box47: OffCheck Box48: OffCheck Box49: OffGroup33: OffGroup34: OffCheck Box50: OffCheck Box51: OffCheck Box52: OffGroup35: OffGroup36: OffCheck Box53: OffCheck Box54: OffCheck Box55: OffGroup38: OffGroup39: OffCheck Box56: OffCheck Box57: OffCheck Box58: OffGroup40: OffGroup41: OffCheck Box59: OffCheck Box60: OffCheck Box61: OffGroup42: OffGroup43: OffCheck Box62: OffCheck Box63: OffCheck Box64: OffGroup44: OffGroup45: OffCheck Box65: OffCheck Box66: OffCheck Box67: OffGroup46: OffGroup47: OffCheck Box68: OffCheck Box69: OffCheck Box70: OffGroup48: OffGroup49: OffCheck Box71: OffCheck Box72: OffCheck Box73: OffGroup50: OffGroup51: OffCheck Box74: OffCheck Box75: OffCheck Box76: OffGroup52: OffGroup53: OffCheck Box77: OffCheck Box78: OffCheck Box79: OffGroup54: OffGroup55: OffCheck Box80: OffCheck Box81: OffCheck Box82: OffPrimary Name: Primary Name 2: Primary Title: Primary Title 2: Primary Email: Primary Email 2: Primary Address: Primary Address 2: Primary Address 3: Primary Phone: Secondary Name: Secondary Name_2: Secondary Title: Secondary Title 2: Secondary Email: Secondary Email 2: Secondary Address: Secondary Address 2: Secondary Address 3: Secondary Phone: Revision #: Contract Number: CP User Name: CP User Title: CP User Email: CP User Address 1: CP User Address 2: CP User Address 3: CP User Phone: CP User Name_2: CP User Title_2: CP User Email_2: CP User Address 1_2: CP User Address 2_2: CP User Address 3_2: CP User Phone_2: CP User Name_3: CP User Title_3: CP User Email_3: CP User Address 1_3: CP User Address 2_3: CP User Address 3_3: CP User Phone_3: CP User Name_4: CP User Title_4: CP User Email_4: CP User Address 1_4: CP User Address 2_4: CP User Address 3_4: CP User Phone_4: CP User Name_5: CP User Title_5: CP User Email_5: CP User Address 1_5: CP User Address 2_5: CP User Address 3_5: CP User Phone_5: CP User Name_6: CP User Title_6: CP User Email_6: CP User Address 1_6: CP User Address 2_6: CP User Address 3_6: CP User Phone_6: CP User Name_7: CP User Title_7: CP User Email_7: CP User Address 1_7: CP User Address 2_7: CP User Address 3_7: CP User Phone_7: CP User Name_8: CP User Title_8: CP User Email_8: CP User Address 1_8: CP User Address 2_8: CP User Address 3_8: CP User Phone_8: CP User Name_9: CP User Title_9: CP User Email_9: CP User Address 1_9: CP User Address 2_9: CP User Address 3_9: CP User Phone_9: CP User Name_10: CP User Title_10: CP User Email_10: CP User Address 1_10: CP User Address 2_10: CP User Address 3_10: CP User Phone_10: CP User Name_11: CP User Title_11: CP User Email_11: CP User Address 1_11: CP User Address 2_11: CP User Address 3_11: CP User Phone_11: CP User Name_12: CP User Title_12: CP User Email_12: CP User Address 1_12: CP User Address 2_12: CP User Address 3_12: CP User Phone_12: CP User Name_13: CP User Title_13: CP User Email_13: CP User Address 1_13: CP User Address 2_13: CP User Address 3_13: CP User Phone_13: CP User Name_14: CP User Title_14: CP User Email_14: CP User Address 1_14: CP User Address 2_14: CP User Address 3_14: CP User Phone_14: 3rd Party Entity Name: 3rd Party Name: 3rd Party Title: 3rd Party Email: 3rd Party Address_1: 3rd Party Address_2: 3rd Party Phone: 3rd Party Entity Name_2: 3rd Party Name 2: 3rd Party Email_2: 3rd Party Address 1_2: 3rd Party Address 2_2: 3rd Party Phone_2: 3rd Party Entity Name_3: 3rd Party Name 3: 3rd Party Title 3: 3rd Party Email_3: 3rd Party Address 1_3: 3rd Party Address 2_3: 3rd Party Phone_3: 3rd Party Entity Name_4: 3rd Party Name 4: 3rd Party Title 4: 3rd Party Email_4: 3rd Party Address 1_4: 3rd Party Address 2_4: 3rd Party Phone_4: 3rd Party Entity Name_5: 3rd Party Name 5: 3rd Party Title 5: 3rd Party Email_5: 3rd Party Address 1_5: 3rd Party Address 2_5: 3rd Party Phone_5: 3rd Party Entity Name_6: 3rd Party Name 6: 3rd Party Title 6: 3rd Party Email_6: 3rd Party Address 1_6: 3rd Party Address 2_6: 3rd Party Phone_6: 3rd Party Entity Name_7: 3rd Party Name 7: 3rd Party Title 7: 3rd Party Email_7: 3rd Party Address 1_7: 3rd Party Address 2_7: 3rd Party Phone_7: 3rd Party Entity Name_8: 3rd Party Name 8: 3rd Party Title 8: 3rd Party Email_8: 3rd Party Address 1_8: 3rd Party Address 2_8: 3rd Party Phone_8: 3rd Party Entity Name_9: 3rd Party Name 9: 3rd Party Title 9: 3rd Party Email_9: 3rd Party Address 1_9: 3rd Party Address 2_9: 3rd Party Phone_9: 3rd Party Entity Name_10: 3rd Party Name 10: 3rd Party Title 10: 3rd Party Email_10: 3rd Party Address 1_10: 3rd Party Address 2_10: 3rd Party Phone_10: 3rd Party Entity Name_11: 3rd Party Name 11: 3rd Party Title 11: 3rd Party Email_11: 3rd Party Address 1_11: 3rd Party Address 2_11: 3rd Party Phone_11: 3rd Party Entity Name_12: 3rd Party Name 12: 3rd Party Title 12: 3rd Party Email_12: 3rd Party Address 1_12: 3rd Party Address 2_12: 3rd Party Phone_12: 3rd Party Entity Name_13: 3rd Party Name 13: 3rd Party Title 13: 3rd Party Email_13: 3rd Party Address 1_13: 3rd Party Address 2_13: 3rd Party Phone_13: Name Print: Signer Title: