AgentCalcs Software Order Form

Name

Company

Address

City State Zip

Country Phone

Email

Unit Price
Item Quantity Price
(US Dollars)

Perpetual Licenses (Do Not Expire)

HFC-227ea – 25 bar (360 psi) $6,000
HFC-227ea – 42 bar (600 psi) $6,000
HFC-125 – 25 bar (360 psi) $6,000
HFC-125 – 42 bar (600 psi) $6,000
HFC-23 $6,000
FK-5-1-12 – 25 bar (360 psi) $6,000
FK-5-1-12 – 42 bar (600 psi) $6,000
IG-01 $6,000
IG-100 $6,000
IG-541 $6,000
IG-55 $6,000
3-Year Licenses
AgentCalcs for CO2 – New 3-year license $1,500
AgentCalcs for CO2 – 3-year license $1,000
renewal
Total

Payment Information

Payment can be made with your Visa or MasterCard credit card. Please complete the attached credit
authorization and return to us with the completed order form. If you would like to pay via check or wire
transfer, please contact us directly for additional information.

O: +1 410-
410-737-
737-8677
F: +1 410-
410-737-
737-8688

3610 Commerce Drive | Suite 817

Baltimore, MD 21227 USA

jensenhughes.com
AGENTCALCS SOFTWARE ORDER FORM PAGE 2

Credit Authorization Form

I authorize Hughes Associates Inc. to charge my credit card for services

rendered, not to exceed the amount shown.

Credit Card Type Visa MasterCard

Account Number

CCV# (3-digit)

Expiration Date

Name on Card

Billing Address

Billing Zip Code

Phone Number

Amount (USD)

SIGNATURE DATE

FAX, E-MAIL OR MAIL TO:

JENSEN HUGHES, INC.
3610 Commerce Drive, Suite 817
Baltimore, MD 21227
Ph: (410) 737-8677
Fax: (410) 737-8688 fax
E-mail: orders@jensenhughes.com

For office use only

Order Number

JENSEN HUGHES