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
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Reseller contact