Pre-printed label form

Please provide the following customer information:

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL

Please provide the following product information:

Type of Label:

Select One Asset Label Location UPC Harsh Environment Specimen Label Other: Specify Below

Other:

Type of Material:

Select One Paper Synthetic Poly Fabric

Quantity:

Size of Lable in inches: Width: Height:

Surface label will be applied to:

Temperature range when lable is applied: Min. Temp (F) Max. Temp (F)

Temperature range after lable is applied: Min. Temp (F) Max. Temp (F)

Adhesive: Select One Permanent Removable

Will label be subjected to Harsh Environment Pressures: Yes/No Yes No

If Yes, indicate which one: Select One Moisture Abrasion UV Exposure Other

If other, please describe:

Label will remain: Select One Indoors Outdoors

Which Bar Code Symbology do you want? Select One Code 39 Code 128 PDF 417 UPC Data Matrix 2D Other

Other:

Indicate Starting Bar Code Number:

Do you want Human Readable under Bar Code? Yes/No Yes No

Do you want consecutive numbering? Yes/No Yes No

Will you be providing Data Source from a file? Yes/No Yes No

Do you want text to appear above Bar Code? Yes/No Yes No

Text to appear above Bar Code:

Labels will be printed black unless otherwise specified.

Other Color:

Other Comments: