Custom Bar Code Label Order Form

Fill out as much of the form below as possible or download a print version (pdf 386KB) and fax to 800-466-1165.
A Vernon bar code label specialist will contact you as soon as possible to help you complete your purchase.

Customer Number (if known):
Name:
Institution Name:
Title:
Phone:
Fax:
Mailing Address:


City:
State:
Zip:
Residence or Business:
Delivery Address: (if different)

City:
State:
Zip:
Residence or Business:
Email:

Item number:
Quantity:
Heading above the bar code:
(maximum 27 characters for 1.6" wide bar codes)
(maximum 35 characters for 2.0" wide bar codes)
Name of circulation software:
Bar code symbology (if known)
Bar code will be used for:
Permanently placed leading digit (if used):
If digits 2 through 5 are a location code, please enter it here:
Does your software require a check digit?
Total number of digits (including check digit if needed):
Start number (please include entire number):
Stop number (please include entire number):

If possible, please fax (1.800.466.1165) or mail us samples of your existing bar codes. Feel free to call us (1.800.878.0253) for assistance in filling out this form.

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Custom Bar Code Label Order Form

Custom Bar Code Label Order Form

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Custom Bar Code Label Order Form

Custom Bar Code Label Order Form

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