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Basic Information
Expected Production Date:   
Customer Name:  
Customer Name:
Customer Name:
Sales Rep:
Customer #:   
Customer #:
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 CT through a VAN or 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:  
Attachments
1) 
2) 
3) 
4) 
5) 
 
EDI Specification
Receiver ID Test:  
Receiver ID Production:  
Qualifier ID:    
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 CT?   
If yes, list customer name:  
Are you a 3PL who represents multiple customers?  
Will will you be sending a unique identifier or Bill to Vendor code to identify each customer?  
Please provide the unique Bill to Vendor code or reference identifier for each customer you entered above:  
 
 
Does your company send a 997 back for 210 transmissions?  
If Yes, specify which one:    
 
  • Please submit specifications with this profile.
  • Submit example of test file if possible.

 
      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.

  




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12/14/2019 - 5:06 PM
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12/14/2019 - 5:06 PM
12/14/2019 - 5:06 PM