—Please choose an option—Ford EUFord NAGates
*Ford Supplier Code (GSDB)
*Ford Supplier Code (V)
*Gates Supplier Code
*Company Name
Plant/Division
*Address
*City
*State/Province
*Zip/Postal Code
*Country
Tax Exempt Number
*First Name
*Last Name
Phone Country Code
*Area Code
*Phone Number (no area code)
Extension
Fax Area Code
Fax Number
Email
*Labels are web portal generated YesNo
*Printer —Please choose an option—CabDatamaxIntermecLaserPrintronixSatoZebraOther
Printer Make/Model
Printer Part Number
*Verifier —Please choose an option—HHPPSCStratixOtherNone
Verifier Make/Model
Verifier Part Number
*Scanner —Please choose an option—PsionHHPIntermecPSCRJSSymbolWelch AllynOther
Scanner Make/Model
Scanner Part Number
Software
Software Title
Software Version
*Media —Please choose an option—Direct ThermalThermal TransferLaserDot MatrixOther
*Media Style —Please choose an option—CardAdhesive LabelTag
*Media Material —Please choose an option—PaperSynthetic
Is there any additional information we should know about this project?
*Please contact me regarding purchasing ready made formats, barcode equipment, software, and/or media. YesNo
*Number of label formats for Certification.
How would you like to pay? You will receive an email with payment instructions. Credit Card/PaypalWire Transfer (Additional Processing Fee Applies)
