Attachment_0010-_DCGS-A_CM_SWP_Request_MC_Clean.pdf

PM DCGS-A CM & SW Licensing K01-SWPR-FRM, REV G Software Product Request Form March 2015

UNCLASSIFIED//FOUO

Complete by Submitter Government POC: * ________________________________________________ Requestor Name: * _____________________________________________________ Contractor: * _____________________________________________________ Shipping Address:*

City, State:* __________________ Zip Code:* _____ Phone Number (s):* ______________________________________________________ Country:* ______ E-mail Address:* _______________________________________________

Note: * required field Note: if classified material is required, please provide classified shipping address.

Outer label is addressed to the “Security Office(r)” automatically.

Software Work Product Request Information Title:___________________________________________________________ Description:____________________________________________________ Version:____________________________ Revision: _______________________ Classification: Classified: PM DCGS-A

Unclassified: Baseline Version:

Quantity of Licenses Required: _______ Number of Copies: _______________

Justification for SWP Request

Electronic Signature

Date: ____________________________________________________________________ Electronic Signature

PM DCGS-A Approval:

Date: ____________________________________________________________

C2I 13.2.5

BCSS 5.0.5

Justification:

In support of BN solution effort