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Riverbed Technology, Inc.
Account Merge, Name Change, Asset
Transfer Form
Requested By (Check one):
Distributor /VAR__V
End Customer___
Request is as a result of (Check one and include press release for Name
Change and Merger/Acquisition):
Name Change__V
Merger/Acquisition__
Other __
If you check ‘Other’, please explain, for e.g. End Customer canceled order, so selling to
a different end customer
Name of Partner (Distributor or VAR) facilitating the change:
Distributor : Mtech
VAR : PT. Nusantara Compnet Integrator
The use of Riverbed Technology, Inc. (“Riverbed”) products listed below
shall be subject to the terms and conditions located at
www.riverbed.com/license (EULA). If a distributor or VAR is involved with
the product transfer request, it is their responsibility to pass on the terms
of the EULA to the new end user per the terms of their partner agreement
with Riverbed.
Riverbed Technology
Name Change/Product Transfer Form
***If you already have a spreadsheet you can attach document along with your signed approval. ***
Serial number
Original End Customer
New End Customer
EC5SJ000FB658
Oto Multiartha, Pt
Summit Oto Finance PT
EC5MQ000FB60F
Oto Multiartha, Pt
Summit Oto Finance PT
EC5YM000FB591
Oto Multiartha, Pt
Summit Oto Finance PT
EC5YN000F7B31
Oto Multiartha, Pt
Summit Oto Finance PT
EC5RH000F9EBE
Oto Multiartha, Pt
Summit Oto Finance PT
EC5UM000FB533
Oto Multiartha, Pt
Summit Oto Finance PT
EC5UG000FB55B
Oto Multiartha, Pt
Summit Oto Finance PT
Customer or Distributor/VAR:PT. Nusantara Compnet Integrator
Name of Authorized Representative: Erlangga ([email protected])
Signature: -ApprovedDate:28 january 2020
Page 2 of 2
New Address
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