EnVista - New Client Form



This form is to be completed when a myShipINFO or CAN contract has been signed. The purpose of this form is to obtain the necessary client information in order for the client to be setup. You are required to fill this form out completely. Please Copy Tricia Stitz, John Stitz, Dan Coppersmith, Deb Boothman and Ashley Bell

|Sales Rep: |William Hippe |

|Account Manager |Deb Boothman |

Client Name: ArthroCare Corporation Client Code: XXXX Hourly Billing Rate: N/A

(If Applicable)

Project Type (Check all that apply)

X FAP-Parcel X FAP-NSP Bill Payment (NO) X G/L Coding

CAN-Parcel CAN-NSP

CAN-Data Analytics (Hourly) CAN-Data Analytics (Fixed Fee)

Customer Type X Billable Customer Proof of Concept (do not file)

Trial (file for credits, but do not bill customer) for _____ weeks

Service Agreement Execution Date: 10/18/2011 NDA Execution Date: XXXX

Client Contact Info #1: Send Invoice to: AP Contact

|Name: |ArthroCare Corporation | |Name: |ArthroCare Corporation |

|Contact: |Bernd Schmalz | |Contact: |Molly McArthur |

|Title: |Director | |Title: |Accounts Payable |

|Address: |7000 West William Cannon Drive, Bldg, 1 | |Address: |7000 West William Cannon Drive, Bldg, 1 |

| |Austin, Texas, 78735 | | |Austin, Texas, 78735 |

| | | | | |

|Phone No: |512-391-3900 | |Phone No: |512-391-3978 |

|Fax No: | | |Fax No: | |

|Email Address |Bernd.Schmalz@ | |Email Address |molly.mcarthur@ |

Client Contact Info #2:

|Name: |ArthroCare Corporation | | | |

|Contact: |Daniel Arias | | | |

|Title: |Freight Cost Analyst | | | |

|Address: | | | | |

| |Costa Rica | | | |

| | | | | |

|Phone No: |506-2209-1559 | | | |

|Fax No: |506-2209-1593 | | | |

|Email Address |Daniel.arias@ | | | |

Effective October 14, 2011, ArthroCare’s address will change to the following:

7000 West William Cannon Drive, Bldg. 1

Attn: Legal Dept

Austin, Texas 78735

Project Description: (Description will appear on invoice code)

|Notes: |Arthrocare invoice audit services |

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Invoice Amount:

The following information will be used when invoicing the customer for the purchase of myShipINFO services.

|FAP Service Fee: |Parcel Invoices: A per package transaction fee of $.030 per transaction |

| |will be assessed on all parcel EDI invoices. |

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| |Non-Parcel Invoices: |

| |A per package transaction fee of $0.70 per transaction will be assess on |

| |all non-parcel EDI invoices submitted. An Excel Spreadsheet showing all |

| |invoices is considered and EDI transmission. |

| | |

| |All Paper Invoices: A per package transaction fee of $1.00 per transaction|

| |will be assessed on all paper invoice submitted for audit. |

|Contingency Fee |0% of Savings: No Contingency Fee |

|FAP Monthly Flat Fee |$ |

| | |

|Transaction Fee: |$ |

|FAP Parcel |$0.03 |

|FAP LTL/FTL (EDI) |$0.70 |

|FAP LTL/FTL (Paper) |$1.00 |

|FAP Ocean (EDI) |$ |

|FAP Ocean (Paper) |$ |

| | |

|CAN Service Fee: |N/A |

|CAN Parcel |     % of Savings |

|CAN Parcel (Fixed Fee) |$ |

|CAN LTL/FTL |     % of Savings |

| CAN LTL/FTL (Fixed Fee) |$ |

|CAN Ocean |     % of Savings |

|CAN Ocean (Fixed Fee) |$ |

|Notes: |ADDITIONAL DISCOUNT for the 1st twelve (12) billing periods of the agreement… |

| | |

| |enVista will provide an additional |

| |Discount of 15% off the monthly invoice to Arthrocare for the first twelve (12) billing cycles of this three (3) year |

| |agreement. |

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| |This is a three (3) year agreement with Arthrocare Corporation |

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Payment Terms:

Net 45 days

Expenses: Bill to Client Do Not Bill

|Notes: |Should not be any expenses. |

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Carrier Support:

X UPS X FedEx DHL X LTL/Common Carrier Ocean Other

|Notes: |Arthrocare ships Intra Europe parcels. they would like us to provide visibility to these shipments initially and when |

| |Intra Europe audit capabilities are available, ArthroCare would like us to audit those invoices too. |

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Carrier Agreement Setup:

|Carrier Agreement(s) on file: |X Yes No NA |

|Late Pick-up Time: | Yes No |

|Close Invoice Using: | Transaction Count (UPS) Closed Count (FedEx) |

|UPS “Waived” GSR Filing - Ground | Yes No On some shippers (see notes) |

|UPS “Waived” GSR Filing - Express | Yes No On some shippers (see notes) |

|FedEx “Ground” GSR Waiver: | Yes No On some shippers (see notes) |

|FedEx “Express” GSR Waiver: | Yes No On some shippers (see notes) |

|Client has enabled Signature Tracking (UPS) | Yes No |

|Notes: |      |

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Electronic Invoice Setup:

|UPS Flat File | Yes No NA |

| |Links will be sent to billingsystem@ |

| |Customer will email files |

| |enVista to download from |

| |User Id: ____________ Password: ______________ |

|FedEx EDI 250 | Yes No NA |

|FedEx On-Line Billing | Yes No NA |

|FedEx Direct Link | Yes No NA |

|LTL (Specify Carrier Name) | Yes No NA |

|Ocean (Specify Carrier Name) | Yes No NA |

|Notes: |      |

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Shipper Account Setup:

|Shipper Account #’s: | |

|(Include Shipper Acct. # and Address Information) |Carrier Setup Fee / Carrier |

|UPS: | |

| |$0.00 |

|0000144F8Y, 000014493W, 00001458WR, 00001479RY, 0000148Y9R, 000023235Y, 00003EA853 – Arthrocare | |

|Medical Corp., Weg Naar Zwartberg 237, Hal 6, 3660 OPglabbeek | |

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|000023235X – Arthrocare Medical Corp., Freight, Weg Naar Zwartberg 237, Hal 6, 3660 OPglabbeek | |

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|FedEx: | |

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|See attached Excel Speadsheet: Arthrocare_FedEXAccount_Master_Report_20111107 | |

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For Internal Team Use

|Date Received/Received By: | | |Date Entered into System | |

| |      | | |      |

|Date of Initial Client Setup | | |Customer Code | |

| |      | | |      |

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