Sticker Tag Order Form
Incomplete forms may cause delays in processing your order!
If you need assistance, please contact your order administration representative .
Complete this form by tabbing between the designated fields and typing the requested information,
making a selection from the drop-down menu, or marking the checkbox. DO NOT use the Enter key
CUSTOMER INFORMATION
Prepared by:
P.O. #:
Shipping Instructions:
Project:
Application
SELECT ONE
BILL TO
Customer Number
Company Name
Street Address
City
Telephone Number
-
-
ext.
State
Zip
State
Zip
E-mail
SHIP TO
Company Name
Address
City
Contact Name
Telephone Number
-
-
ext.
TAG/PROTOCOL INFORMATION
Please use a separate form for each type of tag ordered.
Quantity
Part No.
Description
Protocol *
Option(s)
Dominant
Option(s)
Unit Price
Extended
Price
13-4750-001
eGo Plus Mini WS Sticker Tag, Full Frame
Select One
Select One
$0.00
13-6750-001
eGo Plus Mini WS Sticker Tag, Half Frame
Select One
Select One
$0.00
*IMPORTANT: Match the protocol option(s) with the reader to be used (see Fixed Reader Information section.)
Minimum tag order quantity of 250 for windshield tags
FIXED READER INFORMATION
PROGRAMMING DATA INFORMATION
PLEASE ANSWER ALL QUESTIONS
Select the tag you are ordering:
Programmed Tag
Unprogrammed Tag
ASCII Tag Format:
a) ASCII Format (use drop-down menu): Select One
b) ASCII 4-Character Prefix:
c) First ID (include preceding zeros):
d) Programming: Fill in text fields with numbers, letters, or blank spaces
i. Half Frame
OR
ii. Full Frame
Wiegand Tag Format (Do not enter Wiegand format data if using Full-Frame format):
a) Wiegand Format Name (use drop-down menu): Select One
b) Facility Code:
c) First ID:
End User Name and Location:
Special Instructions:
Reader Type: Select One
Reader Serial Number:
or
Reader Part Number:
IMPORTANT: Reader information ensures that
tag/reader combinations are
compatible.
PREVIOUS PURCHASE ORDER
Please enter the previous Purchase Order Number
pertaining to this installation:
WINDSHIELD STICKER TAG LABEL PRINT INFORMATION
You may request that the Customer ID and SeGo ID be printed in Field #2. In this exception, the manufacture date code and TransCore internal part
number are printed in Field #3. Please refer to the tag order instructions for detailed information on sticker tag label printing.
Field #4, optional text: Select NONE
or enter text (maximum of 29 characters):
Field #3, optional text: Select NONE
or enter text (maximum of 29 characters):
Fields #3 and #4 can be combined into one field and printed in a larger type size. Select NONE
or enter text (maximum of 24 characters):
Field #2 (required): TransCore supplies the Information for this field.
Field #1 (optional): Print Customer ID on label? YES
NO
AND/OR Print Internal SeGo ID on label? YES
Barcode (required): The barcode must contain either the Customer ID or the SeGo ID. Select one:
Customer ID
SeGo ID
Authorized Name on
Purchase Order
Authorized
Signature
NO
Date
E-Mail the completed form to orderentrybox@transcore.com
Refer to Form 600111-005 for complete instructions
600108-005 12/2014