GDPhone_Auth
2
REQUEST FOR VERIFICATION PHONE CALL Starfield Technologies, Inc. Authorized Phone Verification 2009 v. 1.0 10/5/2009 Please sign and scan this document and deliver to the Registration Authority for processing. You can upload via your request console or email to [email protected] Please allow up to 2 business days for an initial response. **Please Note** Comm on Name refers to the Exact Domain URL, Host Name or Code Signing Publisher Name for which the Secure Certificate is being Requested. Common Name of Certificate: ___________________________________________________________________________________ Applicant’s Exact Company or DBA Name: ___________________________________________________________________________________ Corporate Contact First and Last Name: ___________________________________________________________________________________ Current Email Address: ___________________________________________________________________________________ Company Contact’s Phone N umber for Verifi cation Call: [area code + phone] _____________________________________________ Important: Identification Documentation Required: 1) A copy of a current government issued photo ID of the signer of this document. ( driver’s license, state/federal/military ID or passport) 2) A copy of an original document indicating proof-of-right to do business for the exact company name listed above. The following documents will be accepted: Business license Sales & Use Tax certificate “Doing Business As” documentation Fictitious Name documentation Articles of Incorporation Occupational Tax Certificate/License Non-profit Organization Tax Exemption Certificate Charter documentation Partnership Agreement documentation NOTE: Fed. ID Number documents are not acceptable I certify and affirm that I am the duly authorized representative of the company applying for said Secure Certificate AND that I am also a duly authorized representative of the company who can give permission to have the above number called. I agree that neither Starfield Technologies, Inc. nor any of its affiliates shall be liable to me or any other party in any amount for any actions taken pursuant to this request. I hereby waive and release any and all claims related to this request asserted against Starfield Technologies, Inc. or any of its affiliates. Additionally, I agree to defend, indemnify, and hold harmless Starfield Technologies, Inc. an d its affiliates for any loss, liability, damages or expenses, including reasonable attorney’s fees, resulting from third party claim, action or demand related to this request, this authorization, or any actions taken by Starfield Technologies, Inc. in connection therewith. Signed: ______________________________________________________ Date: ____________________________ Printed Name: _____________________________________________________________________________________
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Transcript of GDPhone_Auth
8/3/2019 GDPhone_Auth
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REQUEST FOR VERIFICATION PHONE CALL
Starfield Technologies, Inc. Authorized Phone Verification 2009 v. 1.0 10/5/2009
Please sign and scan this document and deliver to the Registration Authority for processing.
You can upload via your request console or email to [email protected]
Please allow up to 2 business days for an initial response.
**Please Note** Comm on Name refers to the Exact Domain URL, Host Name or Code Signing Publisher Name for which the
Secure Certificate is being Requested.
Common Name of Certif icate: ___________________________________________________________________________________
Applicant’s Exact Company or DBA Name:
___________________________________________________________________________________
Corporate Contact First and Last Name:
___________________________________________________________________________________
Current Email Address:
___________________________________________________________________________________
Company Contact’s Phone Number for Verification Call:
[area code + phone] _____________________________________________
Important: Identif ication Documentation Required:
1) A copy of a current government issued photo ID of the signer of this document. (driver’s license,
state/federal/military ID or passport)
2) A copy of an original document indicating proof-of-right to do business for the exact company name
listed above. The following documents will be accepted: Business license Sales & Use Tax certificate “Doing Business As” documentation Fictitious Name documentation Articles of Incorporation
Occupational Tax Certificate/License Non-profit Organization Tax Exemption Certificate Charter documentation Partnership Agreement documentationNOTE: Fed. ID Number documents are not acceptable
I certify and affirm that I am the duly authorized representative of the company applying for said Secure Certificate AND
that I am also a duly authorized representative of the company who can give permission to have the above number
called. I agree that neither Starfield Technologies, Inc. nor any of its affiliates shall be liable to me or any other party in
any amount for any actions taken pursuant to this request. I hereby waive and release any and all claims related to this
request asserted against Starfield Technologies, Inc. or any of its affiliates. Additionally, I agree to defend, indemnify,
and hold harmless Starfield Technologies, Inc. and its affiliates for any loss, liability, damages or expenses, including
reasonable attorney’s fees, resulting from third party claim, action or demand related to this request, this authorization,
or any actions taken by Starfield Technologies, Inc. in connection therewith.
Signed: ______________________________________________________ Date: ____________________________
Printed Name: _____________________________________________________________________________________
