MSI VS&A Branch Office Form

New Branch Account Form

Please fill out the information below to set up a new branch account with MSI.
Parent Company Name *
Provide the name of the existing MSI partner who will be considered the parent account for the branch offices
Parent Company Billing Contact Name*

First NameLast Name
Parent Company Billing Contact Email*
example@example.com
Parent Company Billing Contact Phone Number*

Country CodeArea CodePhone Number
Parent Company Billing Contact Title*
Additional Billing Contacts
Provide Name, Email, Phone, and Title for any additional Parent Company Billing Contacts

New Branch Office Account Information

If the company name or billing address for the new branch office account is different from the parent account, please fill out the following:
Are you a representative of the parent or branch office?*

ParentBranch
Who is your primary point of contact at your parent account?

First NameLast Name
Email for Primary point of contact
example@example.com
Should invoices for the below branch account be sent to the parent company?*

YesNo
Branch Office Name*
Branch Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Branch Office Billing Contact Name*

First NameLast Name
Branch Office Billing Contact Email*
example@example.com
Branch Office Billing Contact Phone Number*

Country CodeArea CodePhone Number
Branch Office Billing Contact Title*
Additional Branch Office Billing Contacts
Provide Name, Email, Phone, and Title for any additional Branch Company Billing Contacts
Who is your Motorola Solutions account manager or point of contact?*
Signature: I confirm that the above account information is accurate.*

Clear
Name*

First NameLast Name
Title*
Date*

MonthDayYear
Date
Letterhead Attachment*

Please attach a formal letterhead confirming ownership or that the entities are part of the same group.
Cancelof
Should be Empty:

New Branch Account Form