Subscriber'S Organizational Contact

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Subscriber’s Organizational Contact
Note: if you (the Subscriber) entered “Unaffiliated” for your Organization when completing the Subscriber
Information section of the enrollment form, skip this step.
The Organizational Contact form may not be completed or signed by you, the Subscriber. This form must be
completed and signed by a full-time employee within your organization with their name, contact information
and signature.
Name:
____________________________________________________________
Title:
____________________________________________________________
Organization:
____________________________________________________________
Address:
____________________________________________________________
City:
____________________________________________________________
Country:
____________________________________________________________
State:
____________________________________________________________
E-mail Address: ____________________________________________________________
Phone Number: ____________________________________________________________
Fax Number:
____________________________________________________________
DUNS Number: ____________________________________________________________
Symantec can issue an ECA certificate only after establishing that your organization is legitimate and is
registered with an appropriate government authority. You can submit a Dun and Bradstreet (DUNS) number to
prove your organization’s existence and legitimacy, or other “Proof of Organization” document including one of
the following: articles of incorporation, partnership paper, or business license.
I represent that the person identified by the subscriber information on the Subscriber Enrollment Form is
employed or otherwise affiliated with the organization identified above and is authorized to use the resulting
certificate to secure the organization’s transactions.
______________________________________
The Organizational Contact’s Signature

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