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I certify that all the information listed on this form is true to the best of my knowledge. If anything here is found to be untrue, I understand that I may be forfeiting some rights and options listed under ECS' license agreement. Pursuant to the Electronic Signatures In and Global National Commerce Act (ESIGN) of 2000, my typed full name signifies my agreement to the above:
I understand that submitting this electronic application does not create any relationship between ECS and myself, legal or otherwise. I also understand that ECS has full discretion to accept or reject my application for any reason.