First Article/Programming Request


* = required input field
Contact Information:
Name:

First*
Last*
Company:
Address:
City:
State & ZIP:

ZIP Code
Phone:
Fax:
E-mail address:
Eng Contact Phone:

QTY & Basic Info

Qty Finish Part # Rev Select Manufacturer Manu Blank #
Service Needed: Program Serialize Mark T&R

Checksum & Program Data:

Checksum: This is critical data, please provide it if at all possible!
Data: File:

Program Specifications

Ram fill: Word Format: Little Endian Big Endian (AKA Byte Swap)
Data File Offset:
Sector Protect: Details:
Program SecSi Protect: No Yes Boot Locks: No Yes
Software Data Protect: Lock Bits: Other:

Notes & Configuration Settings

Notes:

Marking

Line 1: Mark Type:
Line 2: Ink Color:
Line 3: Other:
Line 4:
Line 5:

Note: Lines may need to be rearranged or modified to fit on the device/label).