Order Prepaid Codes

Prepaid Code Request Form

NOTE: Please allow for up to a 5-business-day turnaround.
  • Customer Information:

  • Format xxxxxx-xxx EX: TESTOH-HQ1
  • Vendor Information

  • Wash Type/Plan Name# of BooksTickets in BookTotal Codes Needed 
  • Plan Name or Generic Series# of CardsBarcodes? (Y/N)Magnetic Strips? (Y/N)Smart Codes? (Y/N) **See Below 
  • Plan Name or Generic Series# of CodesBarcodes? (Y/N)Smart Codes? (Y/N) **See Below 
    Use this portion of the form if you only want a list of codes sent to the vendor.
  • Please Note:

    Separate prepaid series are needed for the following situations, so enter each of them on its own line: Ticket books that have a different number of tickets in them Ticket books that are redeemed for different times Cards for Specific Items ** Please contact your Marketing Representative for information about SmartCodes prior to placing your order. YOU MUST GRANT PERMISSION TO A DRB TECHNICIAN TO ACCESS YOUR SYSTEM. This step is required to complete your order.
  • Acknowledgement:

    By submitting this form I am indicating that I have discussed the cost with the appropriate prepaid card and /or ticket book vendor and am aware of the cost that is involved with the creation of the prepaid cards and /or ticket books. I am authorizing DRB to send the series numbers to the vendor listed above for the creation of the cards and/or ticket books, and I will be held responsible for the cost. Please have the first few codes from each series printed to test before printing all codes in the series. If the codes are printed or formatted incorrectly and do not scan, DRB is not responsible for any reprinting of ticket books or gift cards.
  • This field is for validation purposes and should be left unchanged.