Central Transport - EDI Invoice Setup Request Form

> > >

Basic Information

Expected Production Date:

Customer Name:
Sales Rep:

Customer #:
Sales Rep. Phone:	(555-555-5555)

Contact Information

Primary Contact Information

Secondary Contact information

Name:
Email:
Phone:	(555-555-5555)

Name:
Email:
Phone:	(555-555-5555)

Communication Specification

Does your company plan on connecting to CTII through a VAN or FTP?

VAN

FTP

If VAN is chosen what VAN do you use?

If FTP is chosen list the FTP specs below:

User Name:

Password:

FTP Address or URL:

EDI Specification

Receiver ID Test:

Receiver ID Production:

Qualifier ID:	ZZ 01 Other
If 'Other' has been checked, please provide more details below:

What version will your EDI be setup in:

Do you currently have another setup for another customer with CTII?

Yes

If yes, list customer name:

Does your company send a 997 back for 210 transmissions?

Yes

Please attach a list of names and addresses of your company shipping locations and all locations codes if your Company wants them sent to you on the N104 segment.
Please submit specifications with this profile.
Submit example of test file if possible.
997 Acknowledgements are mandatory for 210 transmissions

All necessary fields must contain correct data or request will not be processed or it will be delayed.
Any questions or problems with the form please contact edi@centraltransport.com.