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Company Name: *

Company Address: *

City: *

State: *

Zip: *

Phone: *

Fax:

Authorized Contact: *

Email:

Part# or RFQ#:

Quantity Needed: *

Material:

Adhesive:

Yes

No

Shape:

Rectangle

Circle

Ellipse

Special

Size

Horizontal:

Vertical:

Tolerance

Tolerance Requirement:

Yes

No

Tolerance +/-:

Corners:

Radius

Square

Holes

# of Holes:

Hole Diameter:

Cutouts

# of Cutouts:

Cutout Dimensions:

Bar-coding (3 of 9):

Yes

No

Consecutive Numbering:

Yes

No

# of Colors to be Printed:

(not including material color)

Type of Color:

Standard

4-color process

Match chip (MUST send by mail)

PMS

Match previous DSD order

PMS #:

(if applicable)

Previous Order #:

(if applicable)

File:

Notes:

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