RFID Tagging Services Contact US Form

RFID tagging services form

By completing this Request for RFID Tagging Services Form, you are indicating that your organization is interested in having ASD Specialty Healthcare, LLC (ASD) affix RFID tags to certain pharmaceutical products on behalf of your organization (RFID Tagging Services).

This form is not a contract and in order to receive ASD’s RFID Tagging Services, your organization must execute a separate RFID Tagging Services Agreement with ASD Specialty Healthcare, LLC.

In order for ASD to generate a value estimate for such RFID Tagging Services, we will need the following information:

First Name:

Last Name:

Job Title:

Primary Pharmaceutical Distributor:

Email:

Phone:

Annual Tag Volume:

Please identify all organization locations interested in receiving ASD’s RFID Tagging Services (Street, City, State, Zip)

Please indicate below where your organization primarily uses RFID tagged pharmaceutical products: Operating Room Crash Carts Other

If you selected "other" please provide the other utilization and usage type:

I attest that I am a representative of the organization requesting ASD Specialty Healthcare, LLC’s RFID Tagging Services and have the requisite authority to request such services on behalf of my organization. yes no