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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:   
Does your company send a 997 back for 210 transmissions?  
 
  • 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.

  






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12/15/2017 - 10:29 PM
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12/15/2017 - 10:29 PM
12/15/2017 - 10:29 PM