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Page 1 of 4 Last revised 01/2018
IdenTrust Global Common (IGC) Certificates VOUCHER ORDER FORM
Vouchers will be issued and sent via email to the Representative designated below. Please allow 24 hoursprocessing time.
Instructions are provided in the email containing the vouchers. Please follow the steps to redeem certificatesand any related hardware and software.
Submit only one order form per purchase order, regardless of how many certificates are being purchased.
You may find the Voucher Purchase Agreement at:https://secure.identrust.com/certificates/legal/Voucher_Purchase_Agreement_v1_1.pdf
Certificates, smart cards, and related Certification Authority services are subject to the terms and conditions of the applicable Certification Policy, Certification Practices Statement and end entity agreements (e.g. Subscriber Agreement) of IdenTrust, copies of which can be found at: https://secure.identrust.com/certificates/policy/igc/index.html
Company Information
Company Name
Representative to Receive Vouchers (Only One Per Request) Telephone
Company Address
City, State, Zip Code Fax Number
Email Address Vouchers Will Be Delivered To
Billing Contact Telephone
Billing Address, City, State, Zip Code
Email Address Invoice Will Be Delivered To Date of request
Notes:
Payment Method
P.O. Number Please include a copy of the Purchase Order with this order form.
Please note: IdenTrust has a minimum requirement of $500 for Purchase Order requests. If your voucher request does not meet this requirement, please follow the Credit Card instructions below. When a P.O. is used, payment is due net 30 days.
Credit Card – Please place your voucher order here: https://secure.identrust.com/tsapp/shop-list.jsp?type=13 There is no need to submit a Voucher Order Form when purchasing vouchers online.
Payment Method
Company Information
Page 2 of 4 Last revised 01/2018
Note: Vouchers are configured exactly as you request. Please be clear in your selection including if the voucher is for a new or
renewal certificate, or both.
Purpose of these vouchers: New certificate(s) Renew certificate(s) Both
*If ordering both new and renew certificates, please specify in the email which are “new” and which are “renew”.
Unaffiliated Software Certificate 1 year ($59) 2 year ($99) 3 year ($139)
Affiliated Software Certificate 1 year ($49) 2 year ($85) 3 year ($109)
Certificate only – 1 year ($69) 2 year ($109) 3 year ($149) User already has Smart card USB token
Certificate and
SafeNet USB token 1 year ($134) 2 year ($174) 3 year ($214)
SafeNet smart card 1 year ($119) 2 year ($159) 3 year ($119)
SafeNet smart card bundle* 1 year ($135) 2 year ($175) 3 year ($215)
SafeNet NG-OTP (Hybrid) USB token** 1 year ($197) 2 year ($237) 3 year ($277)
*Bundle includes an OMNIKEY 3021 smart card reader.*Price includes $60.00 OTP Service license fee.
Certificate only – 2 year ($129) 3 year ($169) User already has Smart card USB token
Certificate and
SafeNet USB token 2 year ($194) 3 year ($234)
HID Crescendo® 144K FIPS smart card 2 year ($179) 3 year ($219)
SafeNet smart card 2 year ($179) 3 year ($219)
HID Crescendo® 144K FIPS smart card bundle* 2 year ($195) 3 year ($195)
SafeNet smart card bundle* 2 year ($195) 3 year ($195)
SafeNet NG-OTP (Hybrid) USB token** 2 year ($257) 3 year ($433)
*Bundle includes an OMNIKEY 3021 smart card reader.*Price includes $60.00 OTP Service license fee.
Quantity Quantity Quantity
IGC Basic Assurance Software
IGC Basic Assurance Unaffiliated Hardware
IGC Basic Assurance Affiliated Hardware
Quantity Quantity
Quantity Quantity Quantity
Page 3 of 4 Last revised 01/2018
Software Certificate 1 year ($89) 2 year ($139) 3 year ($197)
Certificate only – 1 year ($119) 3 year ($269) User already has Smart card USB token
Certificate and
SafeNet USB token 1 year ($184) 3 year ($334)
HID Crescendo® 144K FIPS smart card 1 year ($169) 3 year ($319)
SafeNet smart card 1 year ($169) 3 year ($319)
HID Crescendo® 144K FIPS smart card bundle* 1 year ($185) 3 year ($335)
SafeNet smart card bundle* 1 year ($185) 3 year ($335)
*Bundle includes an OMNIKEY 3021 smart card reader.
Medium Assurance Device Certificate 1 year ($170) 2 year ($275) 3 year ($329)
Quantity Quantity Quantity
IGC Medium Assurance Software
IGC Medium Device
IGC Medium Assurance Hardware
Quantity Quantity
Quantity Quantity Quantity
Page 4 of 4 Last revised 01/2018
Total Number of Vouchers
Subtotal Cost
Shipping option, price per certificate/voucher (select one)
U.S. Mail** (no charge)
FedEx Ground/Home – Free when purchasing new hardware
FedEx Ground/Home – $10.19 (unless purchasing new hardware)
FedEx 2nd Day - $12.33 per voucher
FedEx Standard Overnight - $16.96 per voucher
FedEx Priority Overnight - $19.08 per voucher
FedEx International – TBD when the order is submitted
FedEx Account Number ______________________ (IdenTrust will charge this account for shipping)
Total Shipping
*Sales tax to be applied when shipping to the following states: CA, CO, FL, TX, UT
Total cost of order + applicable taxes
*To receive a quote for sales tax, please call our Customer Support Helpdesk at (800) 748-5360.
**Certificate Welcome Letters will be shipped through U.S. Mail unless: (1) the purchased voucher includes hardware; or (2) a different shipping method was purchased. Shipping applies only after the certificate has been approved.
Please submit this form, along with a copy of your Purchase Order if applicable, to:
Email: [email protected], CC: [email protected]
To pay using a credit card, please call our Sales Customer Support Team at 888-IdenTrust, (866-433-6878).
Thank you for choosing IdenTrust for your digital certificate needs!
Submit Voucher Order Form with Payment
