AgentCalcs Software Order Form

Name
Company
Address
City

State

Country

Phone

Zip

Email

Item

Unit Price
(US Dollars)

Quantity

Price

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

renewal

$1,000
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 410410-737737-8677
F: +1 410410-737737-8688
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