To register for any of EDI Gateway's services or solutions please complete the following form.

Company Name*:
Address:
City:
Country:	Canada United States
Province/State:	Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Zip/Postal Code:
Phone*:	Ext:
Fax:
Contact*:
Email*:
Industry:	= Please select = Apparel Automotive Food Healthcare Manufacturing Pharmaceutical Transportation Wholesale/Retail Other
Are you currently using EDI?		Yes   No
How did you hear about EDI Gateway?		= Please select = Shows Advertising Internet Referral Search Engine Website Word of mouth Other
Company Size (Number of employees)		= Please select = 1-25 26-50 51-100 100-250 250+
How many incoming transactions do you expect monthly?		= Please select = 1-99 100-199 200-299 300-399 400+
How many outgoing transactions do you expect monthly?		= Please select = 1-99 100-199 200-299 300-399 400+
How many trading partners do you have?
Which EDI Gateway product would you like to use:*		MBS
		EDI Outsourcing
		MH10 Labels
		WebGate
		MX Client
		Supply Chain Consulting
What current accounting software do you use?
Questions, Comments?
I would like to receive information and special promotions from EDI Gateway regarding solutions and related services.		yes / no