Proximity card / token analysis form

- If you need help filling out this form or have any questions, you can contact support at support@symcod.com
- Reseller contact
- Company (Reseller)*
- First name*
- Last name*
- Email*
- Phone
- Extension
- Mailing address
- Proximity card / token information
- Indicate for each card / token,
  the exact number that must be returned by our reader.
  
  *** To find this number, read the card where it is - this is in use.
  Note the number that is returned and enter it in the Card # field.
- Card #1*
- Card #2
- Cards / tokens must be returned to the address of the*
- Card / token analysis should be billed to*
- Symcod quotation number (associated with this card analysis)
- Reader interface type*
- The reader will be installed*
- Destination product (LBC-IP, Bridge-IP, TAG-XR, TermiCom ...)*
- Operating system (Windows, Linux, IP library, VT100 ...)
- Notes and comments for analysis
- End user contact
- Name of the company that will use this reader (End user)*
- First name
- Last name
- Email*
- Phone
- Extension
- Mailing address

Reseller contact