Medeco Master Key System Request Form Orders may be delayed without complete information Medeco Use Only (Please print clearly. Use black ink or type directly into form) Registry # Email to [email protected] or fax to 800-421-6615 Key blank # Angle/Ref # Date: End user # Section 1 DISTRIBUTOR LOCKSMITH Account Number: __________________________________ Account Number: _________________________________ Company Name: ___________________________________ Company Name: __________________________________ Street Address: _____________________________________ Street Address: ____________________________________ City, State, Zip: _____________________________________ City, State, Zip: ____________________________________ P.O.# (if applicable) _________________________________ P.O.# (if applicable) ________________________________ Section 2 END USER Orginization Name: _______________________________________________________________________________________ Street Address (no PO Box): ________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________________________ Phone Number: _______________________ Contact Name: _____________________________________________________ Type of Business: _________________________________________________________________________________________ Section 3 IF CARDED, CARD HOLDER NAMES: ALL CARDS SENT TO: __________________________________________________ Name: ____________________________________________ __________________________________________________ Street: ____________________________________________ __________________________________________________ City, State, Zip: _____________________________________ Section 4 q Original q Biaxial q Medeco 3 Biaxial q M4 q Bilevel q Medeco 3 Original Yes No Keyway: Pins: q 5 or q 6 Interchangeable Core? (Now or Future): Cross Keying? Side Codes: q 4 (60 Series only) *Cam/Switch Locks/60 Series *Cam/Switch Locks will not be master keyed with door hardware locks. System Specifications (including expansion): (please enter numbers needed for each level) GGGMK GGMK GMK MK CK Section 5 q Keymark q Medeco X4 q Medeco B Yes No Keyway: Pins: q 6 or q 7 Interchangeable Core? (Now or Future): *Conventional? (6-pin only) *Key-In-Knob cylinders are available in 6-pin only. Not available in Medeco B. System Specifications (including expansion): (please enter numbers needed for each level) GGGMK GGMK GMK MK CK This form must accompany product order if new system. If system only request, email [email protected] or fax to 800-421-6615 Medeco is a brand associated with ASSA ABLOY High Security Group, Inc., an ASSA ABLOY Group company. Copyright © 2020. ASSA ABLOY High Security Group, Inc. 10 All rights reserved. Reproduction in whole or in part without the express written permission of ASSA ABLOY High Security Group, Inc. is prohibited. Medeco Master Key System Request (cont.) PO# ________________________ Section 6 - STAMPING REQUIREMENTS Default stamping will apply unless specified otherwise below. Keys Stamping q Keyset Symbols q Key Bow Style q Alternate (provide separate sheet) (If none selected default will apply) q No Stamping. Blank Keys. Select One q Less Logo q Serialization starting number q Less Keyway q New Die Stamp q Do Not Duplicate (no charge) q Existing Die Stamp q US Property - Do Not Duplicate (no charge) Cylinder Stamping q Keyset q Visual q Less Logo q Alternate (provide separate sheet) Select One q Concealed q Serialization starting number Section 7 - CROSS KEYING For the portion of the system ordered on current PO, all Cross Keying must be noted on PO. Complete below for future requirements. Keyset Symbol: To Be Operated By: q Additional Notes Attached Medeco is a brand associated with ASSA ABLOY High Security Group, Inc., an ASSA ABLOY Group company. Copyright © 2020. ASSA ABLOY High Security Group, Inc. 11 All rights reserved. Reproduction in whole or in part without the express written permission of ASSA ABLOY High Security Group, Inc. is prohibited. Medeco Master Key System Request Form (cont.) PO# ________________________ Section 8 - SHIPPING INSTRUCTIONS FOR BITTING LIST q Only bittings for Keysets ordered with product on this PO (N/C) q Expanded Bitting List (Please provide requirements) Select One: q Email (Preferred, no freight charge) q Provide on Flash Drive (UPS) q Provide on Paper (Standard, UPS) q E-Bitting Portal Email: Ship to: Attn: BITTING LIST FOR KEYWIZARD q Check if Bitting List Required for Keywizard Select One: q Email (Preferred, no freight charge) q Provide on Flash Drive (UPS) q E-Bitting Portal Email: Ship to: Attn: Expanded Bitting List Requirements: Section 9 - CONTACT INFORMATION FOR INDIVIDUAL COMPLETING THIS FORM Name: Phone #: Fax #: Email: Medeco is a brand associated with ASSA ABLOY High Security Group, Inc., an ASSA ABLOY Group company. Copyright © 2020. ASSA ABLOY High Security Group, Inc. 12 All rights reserved. Reproduction in whole or in part without the express written permission of ASSA ABLOY High Security Group, Inc. is prohibited..