Chesapeake - Flowcode Request
Order Number
Order number from billing system
Sales Rep
*
Please use first and last name
Email
*
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Advertiser
*
Website
*
Please provide the URL the QR Code should link off to
Date
*
-
Month
-
Day
Year
When would you like to start using the code? Please keep in mind our turn-around time
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Type of Code
*
Please Select
Standard
Custom
Use Logo
*
Please Select
Yes
No
Logo
Browse Files
Drag and drop files here
Choose a file
If a logos is wanted in the middle of the code, please provide
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of
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Additional Information
If the advertiser paid to have a custom code, please use this area to describe the shape they'd like along with any other details for the QR Code
Advertising
Property
Submit
Should be Empty: