Electronic Data Interchange Trading Partner Agreement Third Party Administrator Attachment
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Electronic Data Interchange Trading Partner Agreement Third Party Administrator Attachment Form. This is a Montana form and can be use in Workers Compensation.
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ELECTRONIC DATA INTERCHANGE (EDI) TRADING PARTNER AGREEMENT Trading Partner Profile Attachment Trading Partners often send reports to DLI/ERD for several insurers or employers. Please complete the following for each insurer or employer Federal Employer Identification Number (FEIN). Insurance company or employer name: ______________________________________________ FEIN: ____________________________ Insurance company or employer name: ______________________________________________ FEIN: ____________________________ Insurance company or employer name: ______________________________________________ FEIN: ____________________________ Insurance company or employer name: ______________________________________________ FEIN: ____________________________ Insurance company or employer name: ______________________________________________ FEIN: ____________________________ Trading Partner Profile Attachment/dje5-27-14 DLI-ERD-WCC044 American LegalNet, Inc. www.FormsWorkFlow.com
