KCS v6 Verified Designation Form

Your Name*

First Last

Your Email*

Company*

Address for delivery of KCS v6 Verified certificate*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

For the KCS Academy website:

Verified Product Name and Version Number*

Link to the Verified product*

Link to the company logo you'd like displayed*

Description of Verified product (100 words or less)*

Name and email for billing if different from your info above

Operations manager Jill DeGraff will be in touch to complete payment.

By submitting this form, you indicate that you have signed and submitted the Verified License Agreement and the Logo Use Agreement to support@thekcsacademy.net. (Opening those agreements in Adobe Reader will allow access to fillable forms.)

Name

This field is for validation purposes and should be left unchanged.