P.O.#:

PST Exempt#:

Reseller Name:

Reseller Contact Name:

Contact Email Address:

Reseller Phone #:

Reseller Fax #:

Company Name:

Contact Name:

Company Email Address:

Company Phone #:

Company Fax #:

Address:

City/Town:

Province/State:

Choose a Province or State Outside U.S. & Canada Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada Newfoundland/Labrador New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territories

Zip/Postal Code:

Company Name:

Shipping Contact:

Shipping Contact Email:

Shipping Contact Phone #:

Shipping Contact Fax #:

Shipping Address:

City/Town:

Province/State:

Choose a Province or State Outside U.S. & Canada Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada Newfoundland/Labrador New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territories

Zip/Postal Code:

Base Package:

EDI*ASSET for Windows (documentation included)

Maintenance Agreements:

EDI*ASSET  

Communications

ASYNC:     

Trading Partner:

VAN:

FTP:        

HTTPS:    

 AS2:       

HOST:                                                     Additional Host Setup

Network Communications:

EDS*ELIT Async Mailbox

Secure FTP

 Non-Secure FTP

AS2

Transaction                          

Mapping Type

Trading Partner