Sample Label Request Form Sample Request Inquiry Form Please fill in the simple form below, and we will send out label samples to your location at no charge. Please state what application you plan to use the labels for as we may be able to suggest an item more suitable for your needs. PolyVoid is only available in 3/4" x 1 7/8" and 5/8" x 1 3/8" label sizes due to the VOID pattern. Fields marked with an asterisk ( * ) are required for a response. 1. Contact Details * Contact Name: Company Name: Contact Phone: * Your Email: 2. Shipping Details * Address: * City: * State / Province: * Country: * ZIP / Postal Code: 3. Label Sample Details * Label Type: Please Select PolyAsset (platinum) PolyAsset (white) PolyBreak (white - Destructible) PolyCheck (chrome - Checkerboard) PolyVoid (3M White - Void) * Label Size: Please Select 3/4" x 1 7/8" 5/8" x 1 3/8" 1/2" x 1" * Label Layout: Please Select Human Readable BELOW Barcode Human Readable ABOVE Barcode Barcode ONLY (no numbering) Numbering ONLY (no barcode) Neither (no barcode no numbering) Barcode Format: Please Select (if needed) Code 39 Code 128 Other Other Barcode Format: Barcode Start #: Increment Barcode By: Duplicate Each Barcode: 0 times 1 time 2 times 3 times Please detail the text to appear on the labels below. Please Note: If a barcode is being used, you will be limited to 2-3 lines of text. Text Line 1: Text Line 2: Text Line 3: Text Line 4: Additional Instructions: 4. Message Details Priority: Low Medium High Urgent How did you hear about us? Select One Google Other Search Engine Referral by Web Site Referral by Person Other * How should we contact you? Phone Email 5. Message Verification * Enter Verification Code: