EDI Profile

EDI Profile

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

Company Information

Company Name
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Phone Number - (###) - ### ####

Fax Number - (###) - ### ####
Email Address
Webpage
(http://www.yourcompany.com)

EDI Contacts

Contact #1
Name

Responsibility

- - Phone Number

Email Address
Contact #2
Name

Responsibility

- - Phone Number

Email Address
Contact #3
Name

Responsibility

- - Phone Number

Email Address

Other Information

Interchange (ISA) Qualifier/ID
Production (ex. 01/003151735)

Test (ex. 01/003151735)
Group (GS) ID
Production (ex. 003151735)

Test (ex. 003151735)
Name of Software/Translator
Do you use a third party network?
Yes No
If so, who?
List your transmission times
Send

Receive

Send

Receive

Send

Receive
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

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

What version of the X12 standard are you using?
(ex. 004010)
Comments

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