Hagen Software Inc. Credit Card Authorization Form

I hereby authorize Hagen Software Inc. to charge my _______________ [Visa/Mastercard] credit card, with account number ____________________ [credit card number] in the amount of US$_____________ [amount] for the purchase of e-Classifieds product licenses and/or services, and I agree to pay this amount according to the card issuer agreement. I hereby acknowledge receipt of services and confirm that they are as described and not defective in any material way. I understand and agree that all sales are final and that there shall be absolutely no refunds under any circumstances whatsoever. I hereby acknowledge my full and unconditional acceptance of all terms of the End User License Agreement as presented to me both in the shopping cart and on the web at "http://www.e-classifieds.net/support/license.html". I also authorize Hagen Software Inc. to bill this or any other credit card that I provide to Hagen Software for any other amounts that become due and owing under the End User License Agreement, including but not limited to fees for installations, upgrades, product customizations, technical support, secure server setup, logo removal, additional services purchased, or any other applicable fees under the End User License Agreement. I agree to pay all such amounts according to the card issuer agreement.

(please sign on the above line)

(please print your name on the above line)

Dated: ___________________


Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud and identity theft. It also ensures that both parties understand the nature of the contract that they have entered into. All information entered on this form will be kept strictly confidential.

Credit Card Imprints (new customers only)

If you are a new customer of Hagen Software, please include imprints of both the front and back of your credit card (including the signature on the card matching the signature above) on a separate page. We ask for this so that we can verify you as the true cardholder and protect you from criminals who would use your card number without your consent. You can make these imprints by photocopy (please use a light setting so the copy is not too dark), by scanning the card, by taking pictures of it with a digital camera, or by placing the card under a piece of paper and using a pencil to "stencil" the card so that the raised numbers show through onto the piece of paper. If you are a current or previous customer of Hagen Software, you do not need to include the imprints.

Where to send this form

Please send this document and the credit card imprints (if applicable) by fax to +1 202-478-0858, or by e-mail to , or by regular postal mail to the following address:

Hagen Software Inc.
730 24th St., N.W., Suite 14
Washington, DC 20037

--------------- Attach Credit Card Imprints below or on a separate page (new customers only) ---------------