CodeDataPlate.com

Custom Plates

Please first select the type of equipment and then complete the rest of the form. When done click 'Submit Order' button once. You will see the order as submitted. You will be contacted shortly. Use a separate form for each car or group that is different. You must select payment method either of Credit Card, PO, or Contact for Quote.
* Required Fields .

Job Name or Job ID:

(This appears on the Plate Envelope for your reference)

Quantity*:

Type equipment*:

Traction
Hydro

Equipment Classification*:

Passenger
Freight
Service

If other advise in Comments below

Mounting Method: (check all that apply)

4 holes
Double Faced Tape

Governmental Authority (AHJ)*:

Original Installation Code (if known)

Date Original Equipment was permitted to be Installed (if Known):

(mm/dd/yy)

State or City ID #(if known)

Check if Original Installation information is unknown or an Original Installation Code Data Plate already exists (Add-on Plate)

Modernization/ Alteration Code and addendum:

A17.1 - (e.g. A17.1a-2005)

Modernization/Alteration Permit Date:

(mm/dd/yy)

Modernization Items - check those that apply and describe if required:

Comments: Any other items modernized or any additional information or comments:

Check if faxed approval drawings are required *Note: Include the following only* when ordering Large Plates (4" x 8"). (Job Name or Job ID, when provided, is always printed on the plate envelope for reference during field installation.)**
Put company name on plate:
Put job number on plate:
Put car number on plate:

Shipping method pricing will be provided to you before we finalize your order.

Requested Delivery Date: (mm/dd/yy)

Shipping Method:
Regular Ground - 7/10 days
Priority - 3/4 days
Express - 1/2 days

I am a returning customer. Please use my billing and shipping information on file.

Company:

Branch:

Information below may be omitted, except for changes.

Ship TO:
Company:
Attention:
Address:
City:
State:
Zip:

Bill TO: Use Shipping Information
Company:
Attention:
Address:
City:
State:
Zip:

Payment Method: Visa or Master Card - We will send you and Order Acknowledgement Form if necessary which must be faxed back when completed. Established Customers P.O. No:
Authorizing Party:
Customer Type: Elevator Contractor, Consultant or Inspection Company University Elevator Shop or In-house maintenance organization Building Owner/Manager/Agent
Contact*:
Phone (XXX-XXX-XXXX)*:
Please send me a quote first via: email fax phone
Fax (XXX-XXX-XXXX):
Email* :