Request form #1: For an IEEE 1451.4-2004 manufacturer ID

Requestor/company hereby agrees to indemnify and hold IEEE harmless from any claim arising out of Requestor's use of assignments or misuse of any assigned number. Signor agrees to notify IEEE of any changes of address or contact information. IEEE Registration Authority is unable to process any application without acceptance of the indemnification statement.
I Accept
I Do Not Accept

Every IEEE 1451.4-2004 transducer is identified by a 64-bit Basic TEDS, containing a 14-bit manufacturer ID. The basic TEDS with the contained manufacturer ID allows unambiguous identification of the transducer and association of the transducer with the template to be used in reading or writing TEDS data.

This form may be used to request a manufacturer ID. Please submit a separate form for each request. IEEE does not honor requests for applicant-specified identifiers.

The application can be faxed or mailed. Requests for a manufacturer ID will be honored within seven (7) business days of receipt of the fee. Requests for a second manufacturer ID , by an existing holder, must be accompanied by an affidavit on company letterhead, confirming that the new number will not be used until the usage of the original number has reached 95%, as defined here.

Please make sure that all sections of this form are completed.

TO BE COMPLETED BY REQUESTOR:   Administrator's Name (if different from requestor)
________________________________________   ________________________________________
Requestor Name   Administrator Name
________________________________________   ________________________________________
Organization Name   Organization Name
________________________________________   ________________________________________
Mailing Address   Mailing Address
________________________________________   ________________________________________
Mailing Address Line 2   Mailing Address Line 2
________________________________________   ________________________________________
Phone Number   Phone Number
________________________________________   ________________________________________
Fax Number   Fax Number
________________________________________   ________________________________________
E-mail Address   E-mail Address
________________________________________   ________________________________________
URL   URL
________________________________________   ________________________________________

I wish to apply for an IEEE 1451.4-2004 manufacturer ID. I have enclosed the fee or have made arrangements to wire funds to the IEEE.

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______________________________________ _______________ ______________________
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Requestor/company hereby agrees to indemnify and hold IEEE harmless from claim arising out of Requestor's use of Assignments or misuse of any assigned number.

_________________________________________________ _____________________________________
Your signature Date

Please return completed form to:

IEEE Registration Authority  
IEEE Standards Association Phone: +1 732-465-6481
445 Hoes Lane Fax: +1 732-562-1571
Piscataway, NJ 08854 USA e-mail: ieee-registration-authority@ieee.org