Download AGENCY EXPERT* for Windows* Order Form

AGENCY EXPERT Additional Modules Order Form
– April 27, 2012
To place an order for Additional Modules for the AGENCY EXPERT, please complete this worksheet. Once completed, please FAX
(303-449-0797 or 303-828-0588) or mail (with a method of payment properly defined or a check enclosed) to GBS, Inc. Your order will be
processed and emailed to you the day we receive your request. If you should have any questions, please contact GBS, Inc. Sales Dept. at
800-231-8495 Ext. 505.
GBS, Inc. Account Number:_______________
Please rush my AGENCY EXPERT Additional Modules to:
Email Address:
_________________
Name of Purchaser: ____________________________________ Phone Number (required): __________________________
Name of Agency: _______________________________________________ FAX Number:
__________________________
Name of Contact (if different from Purchaser: ________________________________________________________________
Shipping Address (No P.O. Boxes Please): ___________________________________________________________________
City: __________________________________________ State: _____________ Zip Code: _____________ - __________
Enter your current version of AGENCY EXPERT: _____

 Upgrade Agency Expert from ________version to _______ version. (Call for pricing) 


$ _________
 Custom Screens Building Module $495 (+ add’l. $100/yr. Mandatory Support Fee) *
$ _________
 Laptop Sync. $199 (Internet Sync - $499) (Requires at least one add’l. Computer License at $50/yr. Mandatory Support Fee)* $ _________
 MassFax $199 (+ Addtl. $50/yr Mandatory Support Fee)*
$ _________
 Mass Email $295 (+ Addtl. $50/yr Mandatory Support Fee – Note: Mass Email is included in MGA Version)*
$ _________
 Electronic (.PDF) Forms Module - $395 (+ Addtl. $200/yr Mandatory Support Fee)*
$ _________
 RFP Module - $295 (+ Addtl. $100/yr Mandatory Support Fee)
$ _________
 Network Efax $299 (Includes MassFax) (Requires that you have either an Efax  or MyFax contract)
$ _________
 Network Fax Server 2003 $399 (Includes MassFax) (+ add’l. $50/yr. Mandatory Support Fee)*
$ _________
 Scan Module - Basic $295 (Requires a Twain compliant Scanner) (+ addtl. $50/yr. Mandatory Support Fee)*
$ _________
 Scan Module - Advanced $495 (Requires a Twain compliant Scanner w\ADF) (+ addtl. $50/yr. Mandatory Support Fee)* $ _________
 Property / Casualty Module - $595 (+ add’l. $300/yr. Mandatory Support Fee)* - Includes ACORD Forms and Advanced Scanning $ _________
 ACORD Forms - $300 (+ add’l. $250/yr. Mandatory Support Fee)*
$ _________
 Quickbooks Synchronization - $195 (+ add’l. $50/yr. Mandatory Support Fee)*
$ _________
 MS Outlook Synchronization. - $295 (+ add’l. 150/yr. Mandatory Support Fee)*
$ _________
 Multiple Database Module $495 (+ add’l. $200/yr./database Mandatory Support Fee)*
$ _________
(One Database included, add’l. Database Licenses: $200/yr. Mandatory Support Fee each) NOT available with MSDE or SQL
 SQL Express "Back End" $495 (+ addtl. $200/yr. Mandatory Support Fee)*
 SQL "Back End" $995 (+ addtl. $500/yr. Mandatory Support Fee)*
 Web Reporting - $995 (+ add’l. $200/yr. Mandatory Support Fee)*
Add’l Multi-User Licenses: $100 each (+ add’l $25/yr support)**
for ____ Workstations *
Add’l Computer Licenses: $50 each (+ add’l $50/yr support)
for ____ Computers *
Add’l Multi-Database Licenses: ( add’l $200/yr support)
for ____ Databases *
Terminal Services Licenses: $50/yr each (min of 2 licenses)
for ____ Licenses *
Access Database Unlock: $100 (+ add’l $100/yr Support Fee)*
Replacement Install/Update Disc for Version ______ $25 for US Mail or $35 for Overnight
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$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
* Note: Support charges for any purchase that has an associated support fee are prorated.
** Note: + add’l $50/yr support for MGA version
Colorado Residents must pay sales tax of 7.2% (Note: there is no sales tax on support services):
Sub Total
Sales Tax
Shipping Charge
Total Charge
$ _________
$ __________
$ _________
$ _________
Desired Payment Mode:  VISA  MasterCard  AMEX  Discover  Check Enclosed
Card Number: __________________________________ Expires: _________ Credit Card Security Code #: ________
Credit Card Address (to which Statements are Mailed):___________________________________ Billing Zip Code: _________
REFUND NOTICE!
The undersigned authorizes GBS, Inc. to charge the above card for the specified amount. Shipping, Data importing, Conversion charges
and Renewal fees are NOT refundable. There is a charge for damaged or missing materials. ALL returns will be charged a $50 Restocking
fee. To receive a refund, the purchased materials must be received by GBS no more than 60 days from the shipping date. This agreement
shall be governed by Colorado Law and venue shall be proper in Boulder county, State of Colorado.
Signature (Required): ________________________________________ , Title: _________________ Date: _______________
AddlModulesOrder.rtf (ADDL MODS ORDER)