Note: This is available only to companies currently enrolled in AS2 Self-Paced Conformance Test

     * The following information is required

* Is this a connectivity problem with the DGI server? Yes or No
(please check one)

Please provide InSitu Test Request ID number(s) involving the issue:

*Description of Problem:

Technical Contact

This person is the primary technical point of contact who is requesting technical support.

Technical Contact
*First Name:
*Last Name:
*Title:
*Address:
*Phone:
*eMail:

Accounts Payable Contact

This is the person with the authority to approve payment of invoices.

Check here if the Accounts Payable contact is the same as the Technical Contact

Name and Title:
Address:
Phone:
Fax:
eMail: