Gentek PEP Automotive Supplier Portal EDI Questionaire Form

Gentek PEP Supplier Questionaire Form
(*Required Fields)

	EDI CONTACT INFORMATION
COMPANY NAME:	*
FIRST NAME:	*
LAST NAME:	*
TITLE:
ADDRESS LINE 1:	*
ADDRESS LINE 2:
ADDRESS LINE 3:
COUNTRY:	*
CITY:	*
STATE / PROVINCE:	*
ZIP / POSTAGE CODE:	*
PHONE NUMBER 1:	*
PHONE NUMBER 2:
FAX NUMBER:
EMAIL ADDRESS:	*
CORPORATE WEB SITE:
TIME ZONE:	*
	BILLING ADDRESS
COMPANY NAME:
CONTACT:
ADDRESS LINE 1:
ADDRESS LINE 2:
ADDRESS LINE 3:
COUNTRY:
CITY:
STATE / PROVINCE:
ZIP / POSTAGE CODE:
	SHIP TO ADDRESS
COMPANY NAME:
CONTACT:
ADDRESS LINE 1:
ADDRESS LINE 2:
ADDRESS LINE 3:
COUNTRY:
CITY:
STATE / PROVINCE:
ZIP / POSTAGE CODE:

	EDI INFORMATION
*	What is your Company's DUNS Number?

Trinary will be setting-up appointments to arrange dates and times to set-up your organization on the web-forms product and conduct a one-hour training session. This training session will show users how to navigate and use Trinary’s web-form product.

Additional Comments:

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