EDI

EDI Profile Application

If you are interested in becoming an EDI Trading Partner, please fill out and submit the below EDI Application.

* is required field

Company *
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number *
Fax Number
Email Address *
Web Site
Contact Information

Please provide a contact below.
Contact Name
First / Last Responsibility Phone Number Email Address
EDI Information

Enter Your EDI Information.
Interchange (ISA) Qualifier/ID *
Production (ex. 01/003151735) Test (ex. 01/003151735)
Group (GS) ID *
Production (ex. 01/003151735) Test (ex. 01/003151735)
Name of Software/Translator
Do you use a third party network? *
Yes No
List your 3rd Party Network
List your transmission times
Send Recieve Send Recieve Send Recieve

Time Zone
What do you use for Segment Terminator?
Decimal Hex
What do you use for Element Separator?
Decimal Hex
What do you use for Sub Elem. Separator?
Decimal Hex
EDI Documents

Select Documents you currently use and/or plan to use.

	Current		Future
810 - Invoice	Send	Receive	Send	Receive
820 - Remittance Advice	Send	Receive	Send	Receive
824 - Application Advice	Send	Receive	Send	Receive
850 - Purchase Order	Send	Receive	Send	Receive
855 - PO Acknowledgement	Send	Receive	Send	Receive
856 - Ship Receivetice	Send	Receive	Send	Receive
864 - Text	Send	Receive	Send	Receive
997 - Functional Acknowledgement	Send	Receive	Send	Receive
210 - Motor Carrier Freight Invoice	Send	Receive	Send	Receive