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EDI Request Form

* Required Fields

Company Information

* Company Name:
Street Address:
Country:
State / Province:
City:
Zip Code:

Contact Information:

* Name:
* Title:
* Email:
* Phone:

EDI Information

EDI Message:
Version Partner to Samtec Samtec to Partner
+ Add row
  • Providing specifications and test data accelerates the implementation process.
  • > Please attach your specifications.
  • > Please attach example of test data if possible.
  • Allowed file types: .pdf, .xls, .xlsx, .csv, .doc, .docx
  • 5 megabyte limit per file.
  •  
* Connection Type:

Direct AS2

Production
* URL:
* AS2 ID:
* IP Address:
* Port:
Test
* URL:
* AS2 ID:
* IP Address:
* Port:
Additional Parameters
MDN Modus:
* Attach Prod/Test certificates here:
  • Allowed file types: .zip, .rar, .cer, .p7b
  • 5 megabyte limit per file.
  •  

Location Addresses

* Required Fields"
  • > Fill the following information with the Billing & Shipping addresses of the locations to be setup or attach a seperate listing here.
  • Allowed file types: .pdf, .xls, .xlsx, .csv, .doc, .docx
  • 5 megabyte limit per file.
  •  
Shipping Address
* Address Name:
* Address 1:
Address 2:
Address 3:
Country:
State / Province:
City:
Zip Code:
Billing Address
* Address Name:
* Address 1:
Address 2:
Address 3:
Country:
State / Province:
City:
Zip Code:

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    (1-800-SAMTEC-9)


    1-812-944-6733

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