West Publishing Corporation d/b/a West Government Services (“WEST”) West Renewal/Conversion FormSubscriber Renewal/Conversion Form and Service Agreement • September 24th, 2009 • Texas
WEST PUBLISHING CORPORATION D/B/A WEST GOVERNMENT SERVICESSUBSCRIBER RENEWAL/CONVERSION FORM AND SERVICE AGREEMENT NOTE: INCOMPLETE OR INCORRECT INFORMATION MAY RESULT IN A DELAY OR DENIAL OF YOUR FORMTo submit your form:1. Please type or print all information requested and fax to 866-253-46762. For questions, please call: Representative Name Darin CooleyPhone 817‐312‐4277 ID# 0087770The information submitted on this Subscriber Renewal/Conversion Form and Service Agreement (“Agreement”) will be used to determine eligibility in accessing information provided by West Publishing Corporation d/b/a West Government Services (“West”). West reserves the right to reject this Agreement for any reason whatsoever without explanation or recourse against West and/or its employees or officers. Additionally, the Subscriber hereby authorizes West to independently verify the information provided herein. ORGANIZATION INFORMATION (ALL ITEMS ARE MANDATORY) WEST GOVERNMENT SERVICES ACCOUNT #: 179850 PURCHA
