Premium Support Agreement, Onsite Service Visit, and Maintenance Kits
North America Only

As of January 1, 2015, HM400 systems can no longer be registered for Premium Support.

First Name*
Last Name*
Company*
Phone*
Cell (Mobile)
Email*

Physical Address (On-site visit location)

Street Line 1*
Street Line 2
City*
State/Province*
Postal Code*
Country*

Billing Address

Street Line 1*
Street Line 2
City*
State/Province*
Postal Code*
Country*

Payment Method*
Purchase Order #

If paying by credit card please fax credit card information or provide phone number. Do not enter a credit card number on this form.

Telephone # for Credit Card Info.
Juniper Systems' FAX number: 435-774-8988

On-Site Visit

Primary Contact for On-Site Visit
Name*
Phone*
Email*
P/N   Price   Systems Cost
System Maintenance
(Includes Premium Support)
 
0
Additional System Maintenance
(Includes Premium Support)
 
0
P/N   Price Systems Yrs Cost
11852 Premium Support Plan
(3 years max)
For 11+ systems contact Customer Support at
435-753-1881
0
P/N Maintenance Kit Option   Qty    
20271 HCGG Twin
1335
 
0
20270 HCGG Single
550
 
0
20269 Classic
950
 
0
  Total cost of all items
0
Comments

Premium Support Plan Pricing
Standard
Application Received
May 1 - Oct 31
Price Per Unit
Discounted
Application Received
Nov 1 - Apr 30
Price Per Unit
$695 $345

By checking this box, I agree to the terms expressed in the Terms and Conditions.

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