Consent Decree Compliance

Complaint Form

Please fill in all requested information and mail to:

Microsoft Consent Decree Compliance

Attention: Compliance Officer – Complaints

800 Fifth Avenue

Suite 101-113

Seattle, WA 98104

Complaint No. ______________________

(For Microsoft Use Only)

□	I am submitting a complaint on behalf of a company.

□	I am submitting a complaint on my own behalf.

NOTE: By submitting this form, you acknowledge that this document may be shared with the Department of Justice and the Technical Committee, and that Microsoft may use any Contact Information provided by you to contact you if necessary. Please note that if you do not provide all of the requested information it may limit Microsoft's ability to process your complaint.

Complainant Contact Information:

Representative (Lawyer, law firm, or other party representing the complainant, if

applicable):____________________________________________________________________

Company or Organization Name (if applicable):________________________________________

Individual Name / Contact Name:

First Name:____________________________ Last Name:______________________________

Address :______________________________________________________________________

City:_____________________ State/Province:____________ Zip/Postal Code:______________

Country/Region:________________________________________________________________

Telephone Number:_____________________________________________________________

E-mail (e.g. joe@msn.com):_______________________________________________________

Please select the category below that best describes you:

(Review the Consent Decree on the Consent Decree Compliance web site if you have any questions about the categories.)

□	Covered OEM - Original Equipment Manufacturers

□	OEM - Original Equipment Manufacturers (Royalty OEM)

□	OEM - Original Equipment Manufacturers (System Builder)

□	ISV - Independent Software Vendor

□	IHV - Independent Hardware Vendor

□	IAP - Internet Access Provider

□	ICP - Internet Content Provider

□	End User

□	Other (please specify)

Please select the nature of your complaint:

(Review the Consent Decree on the Consent Decree Compliance web site if you have any questions about the categories)

□	OEM Retaliation (III A.).

□	Uniform License Agreements for Covered OEM's (III B.).

□	OEM License Agreement options or alternatives (III C.).

□	Disclosure of APIs (III D.).

□	Licensing of Communications Protocols (III E.).

□	ISV or IHV Retaliation (III F.1).

□	ISV Agreements (III F.2).

□	IAP or ICP Agreements (III G.2).

□	IAP, ICP, ISV, IHV or OEM Exclusive or Fixed Percentage Agreement (III G.1).

□	Microsoft Middleware Product or Non-Microsoft Middleware Product (III H.).

□	Licensing of Microsoft Intellectual Property to ISVs, IHVs, IAPs, ICPs and OEMs pursuant to the Consent Decree (III I.).

□	Other (Identify the paragraph of the Consent Decree pursuant to which you are making a complaint, below)

Relevant dates of complaint and Microsoft contacts:

Identify the date(s) on which the Microsoft conduct that is the subject of your complaint occurred or commenced. Please provide a date for each specific instance of conduct that is the subject of your complaint and identify (by setting forth the name and location of) any Microsoft personnel or representative with whom you interacted or corresponded:

Please describe your complaint with as much specificity as possible:

We recommend that you provide supporting documentation such as written contracts or correspondence with Microsoft that relates to your complaint. For example, to the extent that your complaint concerns an agreement with Microsoft, please provide a copy of that agreement.

Signature: ____________________________________________________________________

Date: ________________________________________________________________________