Company Name:		Contact Name:
Street Address:		City:
State:	Please select a US state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code:
Telephone Number:		Fax Number:
Email Address:		Confirm Email:
New Customer:	Yes No
Shape of Label:	Please select a label shape Circle Custom Shape Knife Cut Oval Perforated Rectangle Sheeted Square	Dimensions of Label:
Hot Stamp Job:	Yes No
Number of Colors:	Blank 1 2 3 4 5 6 7 8	4 Color Process (CMYK):	Yes No
Quantity Needed:		Finishing:	Rolls Sheeted Fanfold
Scoring:	None Face Back	Sheen:	Glossy Matte Don't know
Varnish:	None UV Other	Over Laminate:	Yes No Don't know
To what will label be applied:	Please describe the surface on which the labels will be applied.
Have artwork:	Yes No	Graphics file format:	Please choose a graphics application Adobe Illustrator Adobe Photoshop Macromedia Freehand QuarkXpress CorelDraw Other
Special Instructions:	Please provide any other details about your label or job that MLX should know.