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First name: ^*

Last name: ^*

Vendor Name: ^*

Phone: ^*

Email: ^*

Fax:

Vendor Number: ^*

Address: ^*

City: ^*

Province/State - Two-Letter State Code: ^*

Postal/Zip Code: ^*

Country - Three-Letter Country Code: ^*

Order Management Model: ^*

Solution: ^*

Trading Partner Relationship: ^*

Comments:

^* These fields are required.