EDI Application

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

Company^*

Address^*

City^*

State / Province^*

Postal / Zip Code^*

Country^*

Website

Contact Information

First Name^*

Last Name^*

Responsibility

Phone Number^*

Email Address^*

EDI Information

Interchange (ISA) Qualifier/ID^* Production

Interchange (ISA) Qualifier/ID^* Test

Group (GS) ID^* Production

Group (GS) ID^* Test

Name of Software/Translator

Do you use a third party network?^*

Yes No

If yes, list your third party network?

List your transmission times

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Receive

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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.

Document	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

What version of the X12 standard are you using?

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