Alignment Authorization Form - Supplier - - Contract Number

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The purpose of the Alignment Authorization Form (AAF) is to document the Member's intent to align to an E&I contract, and to ensure successful alignment after submission. The AAF may be completed only by representatives of E&I member institutions. To determine whether your institution is a member, visit our Member Locator. To join E&I, complete a Membership Application.

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If you have any questions about this form or alignment, please contact your Member Success Manager using our Find my Rep tool.

Institution Information

Institution Name	Title
First Name	Last Name
Phone	Email Address
Department	Primary Role
Please describe your dental program 4 year dental education programHygiene ProgramAssisting ProgramOther	Please describe

Additional Information

Are you an existing customer of this supplier?

YesNoUnsure

Account Number

Areas of Interest

Select multiple options by holding Ctrl key

Other Dealer Partner

eProcurement

Do you use an eProcurement platform?

YesNo

What ePro system do you use?

Do you want this contract enabled on your eProcurement platform?

YesNo

Do you have an immediate business need in addition to aligning your account to the E&I contract?

NoYes

Please provide any further details

If there are other key contacts at your institution that will be working with this supplier, please provide their information below (name, title, email)

Punchout Capable

YesNo