Barcode Order Form
Please fill out this form completely. Do not leave any fields blank.
Need help? Click on the barcode.
Bill To:
Institution Name:
Contact Name:
Telephone:
Check here if this is a new telephone number.
Address:
Check here if this is a new address.
City:
State:
Zipcode:
To assist us in processing your order, please check one:
I am a current customer.
I am automating for the first time.
I am converting from another vendor.
Ordering is as easy as 1 - 2 - 3!
Step 1: Choose one of the following label types:
Polythermal barcode labels (white) - $70/1,000
Polythermal barcode labels (color) - $80/1,000
Please select your color choice below:
Royal Blue
Lilac
Yellow
Green
Fuschia
Laser printed labels with protectors - $80/1,000
Step 2: Choose a barcode symbology:
Code 39 (Code 3 of 9)
Starting number:
Total quantity:
Codabar
Starting number:
Total quantity:
Interleaved 2 of 5
Starting number:
Total quantity:
Comments or Special Processing?
If you have feedback on our products or services or special processing requests, please note them here.
Step 3: Click the Barcode to send your order or Clear Form to start over!
Please send questions or comments to
Deborah Wright, Automation Consultant.
Barcode Order Form
