Prime Vendor, Inc. Federal EDI Registration
Please note: All fields in RED are required. Your registration can not be processed without them.
COMPANY NAME  
   
Address  
  
Line 1  
2  
City  
State/Province  
Postal Code/Zip  
   
Contact Person  
  
1)  
   
Contact Information  
  
Phone   EXT:
Fax  
Email  
   
Forms On File  
  
  W-9
We are required to keep a copy of your W-9 form on file.
Please complete and return form by fax to 1-800-746-8307.
Click here to download the W-9 form.
   
DUNS / CAGE CODE 
  
DUNS #  
CAGE #  
   
Payment Information  
  
Card Holder Name  
Credit Card #  
Card Type  
Expires  
Service Type  

Annual Federal EDI Service,
$695.00 for one client, $295.00 for each additional client.
Unlimited Transactions,
One Time Account Set up Fee $300.00 per client
     
If you are paying by credit card, we will
require an authorized signature. Please
print and complete the credit card authorization form.
Then fax the form to 1-800-746-8307.
 
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