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First Name: Last Name: Title: Company Name: Address: City: State: Zip Code: Phone:(###-###-####) E-Mail Address: Industry: ___ Apparel Banking Consulting Employment Education Food Products Front End General Merch Hardlines Healthcare Insurance Logistics Magazines Management Non-Food Paper Products Perishables Transportation Warehousing Other Describe: Business: ___ Manufacturing Distribution Financial Retail Other Owned: Private Public Are you currently using an EDI VAN? Yes No If yes, which one?: How many trading partners?: Monthly Volume: ___ Less than 5,000 KC 5,000 - 10,000 KC 10,000 - 50,000 KC 50,000 - 100,000 KC 100,000 - 500,000 KC 500,000 - 1,000,000 KC greater than 100,000,000 KC Annual EDI VAN Costs: ___ Less than $10,000 $10,000 - $20,000 $20,000 - $50,000 $50,000 - $100,000 $100,000 - $500,000 $500,000 - $1,000,000 greater than $100,000,000 EDI Standards Supported: ___ X.12 VICS UCS WINS TDCC AIAG TALC EMBARC NWDA COMNET EAGLE HIBCC Version: ___ 4010 3080 3070 3060 3050 3040 3030 3020 3010 below 2000
Are you currently using an EDI VAN? Yes No If yes, which one?: How many trading partners?: Monthly Volume: ___ Less than 5,000 KC 5,000 - 10,000 KC 10,000 - 50,000 KC 50,000 - 100,000 KC 100,000 - 500,000 KC 500,000 - 1,000,000 KC greater than 100,000,000 KC Annual EDI VAN Costs: ___ Less than $10,000 $10,000 - $20,000 $20,000 - $50,000 $50,000 - $100,000 $100,000 - $500,000 $500,000 - $1,000,000 greater than $100,000,000 EDI Standards Supported: ___ X.12 VICS UCS WINS TDCC AIAG TALC EMBARC NWDA COMNET EAGLE HIBCC Version: ___ 4010 3080 3070 3060 3050 3040 3030 3020 3010 below 2000
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