MASTER PURCHASE ORDER WAIVER FORM

This Purchase Order Waiver form is used when a customer does not issue a purchase order for the product or services sold by Medallia.
One Purchase Order Waiver form is required per Program.

To: Medallia Inc. Effective Date:

575 Market Street, Suite 1850
San Francisco, CA 94105 Payment Terms: $0.00 / Annual
Phone: (650) 321-3000 / Fax: (650) 321-3156 Currency: USD

Customer Legal Name:

Louisiana Christian University

Program Name:
CheckMarket

ACCOUNTS PAYABLE INFORMATION PROGRAM APPROVER INFORMATION

Program
Accounts Payable
Sejin Ahn Approver Sejin Ahn
Contact Name:
Contact Name:

Program
Accounts Payable Phone
18.487.7581 Approver 318.487.7581
Number:
Phone Number:

SeJin.Ahn@lcuniversity.edu Program SeJin.Ahn@lcuniversity.edu

Accounts Payable Email:
Approver Email:

Billing Address:

1140 College Dr, Pineville, LA 71360, USA

Shipping Address:

Same as Billing
✔ Address Above

Invoices arising from contracts between the parties for Medallia’s products and services will be routed to the contacts
listed above.

By signing below, Customer affirms:

1) It does not require a purchase order or additional documents to authorize payment of invoices from Medallia.
2) If Customer’s Accounts Payable process is revised to require purchase orders, Customer will use commercially
reasonable efforts to provide Medallia with timely notice of that revision.

Acknowledged by:
Signature:_______________________________________

Sejin Ahn
Printed:_________________________________________

Director of Institutional Research

Title:___________________________________________