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Company Information:
*Name:
Title:
*Company:
*Street Address:
*City:
*State:
*Zip:
*Phone Number:
Ext:
Fax Number:
*E-mail Address:

Would you like an application
engineer to call you? 		Yes No

Convenient time to call? (Central Time)

Part Information
Existing or new part?
Is a drawing of the part
available? 		Yes No
Is a sample of the part
available? 		Yes No
Estimated annual usage?
 
Label Size and Shape:
Label Width?
Label Length (Height)?
Label Shape?
Label Material?
 
Material Specifications?
Agency Certification?
Number of printed colors?
Background Color:
Imprinting by Customer?
Label Finish?
Label Adhesive?
Perforations Between Labels? Yes No
Label Overlaminate?
Auto Applied? Yes No
Consecutive Numbering? Yes No
Printed On Both Sides? Yes No

Finishing Specifications?

 
Number of labels or die cut
parts per package
(ie. rolls, wrap, bag):
Copy Position?
Labels Wound?

Artwork?

Quantities to Quote:

1.
2.
3.
4.
When do you need the labels?

Additional Information:

What are you labeling?
Surface Applied to?
Shape of Surface?
Texture of Surface?
Application Temperature?
Service Temperature?
Environment?
Do you have a target price
per part for your project?  $
Other important information about
your application:

How did you learn about
Tailored Label Products?
If "Other" or "Advertisement":