Today's Date:
February, 2025
Sun
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05
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06
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1
10
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Today
Clear
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OK
Cancel
Invalid value
Requestor First and Last Name:
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Email:
Invalid value
Office Phone: (Format must be XXX-XXX-XXXX)
Invalid value
Cell Phone: (Format must be XXX-XXX-XXXX)
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Requesting Agency:
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Position in Agency:
Invalid value
List of names for requested card(s):
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What agency are the requested card(s) for?:
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Type of card(s) needed:
1. Standard Badge only
2. Key Fob Card only (3 small cards in 1)
3. Accountability Tag Label (each person will have 2 labels)
4. Standard Badge/Key Fob for each
5. Standard Badge/Accountability Tag Label for each
6. Badge/Fob/Label for each
Invalid value
Expiration date associated with card(s): (max 4 years out)
1 year
2 years
3 years
4 years
Invalid value
Delivery Preference:
Postal Mail
Pick-Up
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Address For Mailing
Mailing Address:
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City, State, Zip:
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Other Special Instructions:
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Please allow up to one week for cards to be printed.