| Your Contact Information |
| First Name* |
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| Last Name* |
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| Title |
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| Company |
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| Address* |
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| City* |
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| State* |
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| Zip Code* |
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| Phone* |
Ext. |
| E-mail* |
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| Company Type |
End User Reseller |
| About your label application |
| Quantity Needed |
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| Material |
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| Numbering |
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Adhesive |
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| Applied to: |
Flat Surface Rough Surface Metal Glass Plastic Other |
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(Check all that apply, if other - specify below) |
| Temperature Range(F) |
Low High |
| About your label construction |
| Label/Tag Size |
Width(inches) Height(inches) |
| Alternative Sizes Acceptable? |
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| Perforations |
No Perforations Liner Perforations Label Perforations |
| About your label finishing |
| Finished labels provided on |
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Rolls Sheets Fan Folded Mounted to Signs |
| How many labels per roll/sheet/fold: |
| How did you hear about Universal Label Technologies?*: |
| Please use the space below to tell us more about your barcode application: |
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| Please enter the code: |
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