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ARCOS (Automation of Reports and Consolidated Orders System) EDI (Electronic Data Interchange) Request

ARCOS EDI REQUEST FORM

DATE: _____________
COMPANY NAME: _____________________________________________

DEA REGISTRATION NUMBER: ___________ CENTRAL REPORTING? YES NO
IF CENTRAL REPORTING, LIST SUBSIDIARIES:
___________

___________

___________

___________

___________

___________

___________


___________

___________

___________

___________

___________

CONTACT NAME/PHONE: ____________________________________________________
ARCOS EDI CONTACT NAME/PHONE: __________________________________________
ARCOS EDI CONTACT EMAIL ADDRESS: _______________________________________
FREQUENCY OF TRANSMISSION: QUARTERLY MONTHLY
______________________

_____________

Signature


Date

___________________________________________________________
Printed Name

NOTICE TO USERS
In order to adequately protect the information provided to DEA in ARCOS EDI transaction reports, participants
must take responsibility for safeguarding assigned user names and passwords. Additionally, participants are asked to
immediately notify the DEA of changes in personnel and account information to insure the integrity of the ARCOS
EDI system.
Additional Information/Comments:

ARCOS HELP DESK TELEPHONE NUMBER: 1-800-882-9539

FAX NUMBER: 202-307-8612

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