Supplier EDI Startup Form
PAGE 1 of 2
Fields with an asterisk * are required.
 
SUPPLIER INFORMATION
DUNS Number *
Customer Name *
Parent Company *
Parent DUNS Number *
Address 1 *
Address 2  
City *
US State
(US address only)
    or		 *
Non-US State/Province
(Provide the abbreviated state or province.)		  
Postal Code *
Country *
UCC Block ID *
UCC Block ID  
UCC Block ID  
 
EDI CONTACT INFORMATION
Is your EDI Contact a 3rd party service provider?
* Yes     No
If Yes, enter Service Provider  
Name *
Title *
Email Address *
Confirm Email Address *
Address 1 *
Address 2  
City *
US State
(US address only)
    or		 *
Non-US State/Province
(Provide the abbreviated state or province.)		  
Postal Code *
Country *
Phone Number
(xxx-xxx-xxxx)		 *
Extension  
Fax Number
(xxx-xxx-xxxx)		 *
 
EDI TRANSLATOR INFORMATION
What EDI Version is the vendor trading?
* 3060   4010   4030   4050  
What documents should be set-up for this vendor?
* 214I    810    850    856
Trading partner qualifier and receiver ID:
*  *
EDI Network *
If IBM/QRS selected, enter Network ACCT, Mail Box ID and Node.    
Network ACCT  
Mail Box ID  
Node  
If Other selected, enter EDI Network Name.    
EDI Network Name  
 
CEO INFORMATION
Name *
Email Address *
Confirm Email Address *
Address 1 *
Address 2  
City *
US State
(US address only)
    or		 *
Non-US State/Province
(Provide the abbreviated state or province.)		  
Postal Code *
Country *
Phone Number
(xxx-xxx-xxxx)		 *
Extension  
Fax Number
(xxx-xxx-xxxx)		 *