ABS® Order Form                                  Rev 2/07
Agency Business Systems, Inc.
PO Box 818 Gladstone, OR 97027 – 0818

E-mail: sales@agencybusys.com
Web: www.agencybusys.com
Office: 503 659 6752      Fax: 503 652 6897

Agent Information:  All orders will be confirmed by phone. Please type, or print legibly.

Name: _________________________________________________
Address: _______________________________________________
City, State Zip

Phone: ___________________________________
Fax:______________________________________
E-mail

PRODUCT / OPTION DESCRIPTIONS

ABS Agency Builder: This is the base product to which other options may be added. It is an agency management system designed for 10 or fewer workstations. Startup fee of $199 plus $400 annual license fee covers software, one manual, technical support, and free web updates within major versions (i.e. 2.5 to 2.6) with no charge for additional workstations. All recurring fees are due on the anniversary of purchase. *

ABS Document Manager: An ABS Agency Builder option. This program saves images from scanners or digital cameras, and links them to accounts, policies & family members. Not licensed separately.

ABS Receipt Manager: An ABS Agency Builder option. Prints premium payment receipts, and end-of-day settlement reports for Carrier payment and Trust Account deposits. Not licensed separately.

ABS Dashboard Bridge An ABS Agency Builder option. Allows Farmers agents to update ABS data from Farmers Dashboard. Requires little or no data entry. This updates account, members, auto, fire, life policies including coverage, credit scores, and risk. Not licensed separately.

ABS Offsite Backup: An ABS Agency Builder option. Permits scheduled, unattended backups of your data, stored off site at Web4Agents.com. Requires a separate agreement with Web4Agents.com. Visit their web site for storage pricing. Not licensed separately.

Additional Services: Services may be fixed price, or contracted on a Time and Materials basis. We currently only accept contracts for the conversion of data from another product for use with ABS Agency Builder**, or service to assist licensed users recover lost data (disaster recovery). Service charges are not refundable. We do not charge for evaluation of data from another product to see if it can be used with ABS Agency Builder.

SELECT ITEMS TO ORDER

Amount

ABS Agency Builder – One time $199 Setup + $400 annual license fee * (one manual is included).

$599

ABS Document Manager annual license. *

95

ABS Dashboard Bridge – One time $125 Setup + $125 annual license fee* (Farmers Agents Only).

250

ABS Offsite Backup annual license *. (Note: Web storage charges from Internet Provider not included)

95

ABS Receipt Manager annual license fee *.

110

Additional User Manuals (price is per manual - includes shipping and handling) (no refund)

25

Shipping & Handling with Postal Priority delivery (2-3 days). (no refund)

25

$25

Overnight delivery additional amount. (no refund)

30

TOTAL

Credit Card Authorization: Circle One: VISA         Master Card             AMEX

Account Number
:_____________________________________________________________________ Expires:________ /________ MM/YY

3 Verification Numbers
(back of card): ________________ Name on card: _____________________________________________________

Address where bank mails your bill
:        ________________________________________________________________
(Normally your home or office address).
 
                                  City, State Zip:   ________________________________________________________________

Amount to Charge (total from above): $_________________     Authorized Signature: DATE:___________________________________

* License Fee refund eligibility is at the discretion of Agency Business Systems, Inc. and must be requested during the first thirty days following shipment. Product must be returned in sellable condition within 15 days of the refund request. Refund amount may be reduced in consideration of training and/or technical support provided. Such reduction may be as much as $50 per hour. This applies to setup fees and license fees.
Annual License Fees are due each year upon the anniversary of the first license. Setup fees are collected at the time of first license, or upon re-licensing after a period of inactivity.
** Non-disclosure policy: Agency Business Systems, Inc. retains no rights to data it converts. We do not provide data to List Brokers or other parties. Client data is converted and shipped directly to the agent who provided it. We retain converted data long enough to assure receipt, then it is permanently removed from our system.