Date:

School District Name and Number:

Tax ID#:

Address:

City:

State:

Zip:

Telephone:

FAX:

District Group Coordinators (GC)

Contact Person:

Phone:

E-mail:

Alternate Contact:

Phone:

E-mail:

Schools Authorized to Activate Student Users

District School Name

Principal/Couselor Names

Phone #/E-mail

Monthly Invoice Billing Information: Send monthly invoice to

Name:

Position:

Address:

City:

State:

Zip:

Phone:

Fax:

Email

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