General

 First Name: Last Name:
Title:          
Company:  
Type of Company:    
Address:     
City:         State:     Zip:
Country:     
Phone:           () -
 Fax:                () -
 E-mail:        
Specifications

 Card Stock Type:      
Card Size:                            
    If other, please specify:            
Card Thickness:                                        
Number of Colors:                 
    If other, please specify:            

Metallic Color
Smart Card
Magnetic Strip                         
Hot Stamp
      Signature or Computer Panel
      Scratch Off Panel
      Foil
Finish:                 
Mailing Program

 Carrier Size:                                
    If other, please specify:          

One Up Two Up

Embossing - # of Lines:        
Thermal Printing - # of Lines:
Encoding - What Tracks:       


Additional Inserts:
Yes No

If yes, how many:                         		Final Questions

 Would you like us to send you a sample pack?

     Yes No

Any further questions or comments: