Software/Version Name

Requester's Name

Requester's Phone Number

Requester's E-mail Address

If you represent a Government Agency:

Agency Name (please avoid abbreviations)

Facility Name

Facility Location - city/state

If you represent a Government Contractor:

Contractor Number

Government Agency Name (please avoid abbreviations)

Contractor Name on Contract

User Mailing Address Information:

Office Name

Mail Stop and/or Box Number

Street Address

City/State/Zip

Please Read These Instructions

Printing the Agreement

1. If you are using Netscape, you will need to go to the "file" menu button on the Netscape toolbar and from the menu selections choose "Page Setup." Under "Header," make sure "Document Title" and "Document Location" are deselected. If this is not done, Netscape will print an unwanted header line at the top of the form.
2. Click on the "Get Agreement Document" button below.
3. You will then see a printable agreement document. Again go to Netscape's "file" button and from the menu select "Print".

Returning the Signed Agreement

After you have printed the signable agreement generated with this on-line form, sign and return the agreement by FAX addressed to Christine Ramos at 505-665-6846. When the agreement has been fully executed, you will be provided the requested software and a copy of the license with signatures. If you have questions or have trouble printing the on-line form, please e-mail Christine Ramos at ctramos@lanl.gov.

Christine Ramos
Technology Transfer Division, MS C333
Los Alamos National Laboratory
Los Alamos, NM 87545

phone: 505-665-6846
fax: 505-665-3125
e-mail: ctramos@lanl.gov