Vendor Annual Return

Vendor Annual Return
ICCBBA Vendor Identification Code*
Vendor Name (EXACTLY as it should appear in our database):*
Vendor Type*

Software Vendor - Full LicenseLabel Vendor - Full LicenseMedical Products Vendor - Full LicenseApplication Service Provider - Limited Use LicenseSupporting Vendor - Limited Use LicenseVendor Combined - (Software and Other)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Web Address
Primary Contact
Name*

First NameLast Name
Job Title*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Fax Number

Country CodeArea CodePhone Number
Secondary Contact
Name*

First NameLast Name
Job Title*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Fax Number

Country CodeArea CodePhone Number

Software Vendor

A vendor providing software to customers that generates and/or outputs ISBT 128 data structures.
Are you a Milk Banking Software Vendor?*

YesNo
How many customers you currently supply ISBT compliant software to?*

012 - 910 - 2526 or more
How many users?*
This category includes: blood establishment computer system vendors, vendors of information management systems for MPHO facilities, and on-demand label printing system vendors.

Label Vendor

A vendor who provides pre-printed labels carrying ISBT 128 data structures.
How many pre-printed labels you supply each year?*

0 - 199,999200,000 - 999,9991,000,000 or more

Vendor Combined Software and Other

A vendor who meets the criteria of a software vendor and also provides non-software products/services that use ISBT 128.
How many customers you currently supply ISBT 128 compliant software and non-software products/services to?*

012 - 910 - 2526 or more

Application Service Provider

A vendor who provides a service via a software application that utilizes ISBT 128 reference tables (FIN database, Product Database) but does not generate or output ISBT 128 data structures.
How many customers you currently supply ISBT 128 compliant services via a software application

01 - 1011 - 5051 - 200201 or more

Primary Contact