Eclaim Setup Form
Company Name
  *
Vista Customer Number
  *
Contact Name
  *
Contact Title
  *
Vistaline On The Web User ID
  *
**You must have a Vistaline On the Web ID to use Eclaims. If you do not have one, please fill out the User ID Request Form.
Phone Number
  *
Email Address
  *
* Acceptance of Credit Memos is required in order to participate in the Eclaims program. By submitting this form, you are agreeing to this requirement.