Please provide us with the following information. A mailbox on our network will be created within twenty-four (24) hours. We will email you details immediately upon creation. If you have any questions, please feel free to contact our implementation staff at 1(631) 874-3780 or by email at support@fciwebnet.com.
Please be sure to accurately answer those questions marked with an asterisk(*)
Company Name
Name *

Technical Information
Current Network
Translator *
Hardware Platform *
Internet Access

Mailbox Information
EDI ISA Qualifier & ID *
Login Name (for FTP and/or Web access)
Web Password
Method of Access *
Method of Security (For FTP only) *
If I.P. Authentication, Enter Address:
Email Notification of Errors? optional
Email Notification of Receipts? optional
DES3 Encryption? optional
If yes, enter encryption key here:

Primary Contact
Name (First, Last) * *
Title
Street Address *
Street Line 2
City, St, Zip * * *
Email *
Phone *
Fax
Cellular
Other Phone

FCIWebnet.com
Copyright 2005 Fountainhead Communications, Inc.
35 Nutmeg Drive, Trumbull, CT 06611
Tel:(877) 383-6872 Fax:(877)759-8934