Request Form for IEEE Assignment of an IEEE 1451.4™-2004 Manufacturer ID

Request Form

The review and approval process of the application will be completed in less than ninety (90) days. If IEEE Registration Authority places the application on hold for any reason, the applicant has thirty (30) days to rectify the problem. If the problem is not rectified within thirty (30) days, the application process will be terminated and the applicant can re-apply once they have resolved the issue.

IEEE does not honor requests for applicant-specified identifiers.


Registration Information

(All fields in bold are required. Click ? for more information about each field.)

Part 1

Requestor Information
 
 Requestor Name ?  
 Job Title ?  
 Company Name ?  
 Address Line 1 ?  
 Address Line 2 ?  
 City ?  
 State/Province ?  
 ZIP or postal code ?  
 Country ?  
 Phone Number ?  
 Fax Number ?  
 E-mail Address ?  

Part 2

Administrator Information
 
    Administrator's Name ?  
    Job Title ?  
    Company Name ?  
    Address Line 1 ?  
    Address Line 2 ?  
    City ?  
    State/Province ?  
    ZIP or postal code ?  
    Country ?  
    Phone Number ?  
    Fax Number ?  
    E-mail Address ?  

Part 3

Payment Information

Payment method: ?





Company hereby agrees to indemnify and hold IEEE, its officers, directors, employees and agents harmless from any claim arising out of Company's use 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 Company agreeing to indemnify the IEEE described above by accepting the statement. Signor represents that he or she has the authority to bind the Company to the indemnification obligation.




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