app.smartsheet.com
Open in
urlscan Pro
18.234.11.238
Public Scan
URL:
https://app.smartsheet.com/b/form/8a34c74e26a34496b3e1d4ea1befdc7d
Submission: On November 16 via manual from ES — Scanned from ES
Submission: On November 16 via manual from ES — Scanned from ES
Form analysis 1 forms found in the DOM
<form>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Carrier Name" data-client-type="dropdown" id="qyPpOJ1" class="css-u3yn36 ef83ajd0"><label for="select_input_Carrier Name" id="07dc6be7-c7f1-4a50-9253-eb203904b664"
data-client-id="label_Carrier Name" class="css-1xl1v40 ekxsfat0">Carrier Name<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Carrier Name" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="07dc6be7-c7f1-4a50-9253-eb203904b664" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Region" data-client-type="dropdown" id="R69eLAz" class="css-u3yn36 ef83ajd0"><label for="select_input_Region" id="d46a07ff-0578-4b7f-a0d5-acfc6e3d3123" data-client-id="label_Region"
class="css-1xl1v40 ekxsfat0">Region<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Region" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="d46a07ff-0578-4b7f-a0d5-acfc6e3d3123" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Country" data-client-type="dropdown" id="GlG7L33" class="css-u3yn36 ef83ajd0"><label for="select_input_Country" id="49a2f8b3-d771-49c9-bb49-c1bd1f5140f8" data-client-id="label_Country"
class="css-1xl1v40 ekxsfat0">Country<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Country">
<p>Please select all that apply</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container react-select__value-container--is-multi">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Country" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="49a2f8b3-d771-49c9-bb49-c1bd1f5140f8" value="" aria-describedby="description_select_input_Country"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_File Upload" data-client-type="file_upload" id="ATTACHMENT" class="css-1ylo82b ef83ajd0"><label for="file_upload_File Upload" data-client-id="label_File Upload" class="css-1xl1v40 ekxsfat0">File Upload<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-i0kenq" id="description_file_upload_File_Upload">
<p>Please upload your statement in <strong>excel (xlsx)</strong> format only.</p>
</div>
<div class="css-vqlje4" tabindex="0" data-client-id="file_upload_dropzone" aria-describedby="description_file_upload_File_Upload" aria-disabled="false" style="position: relative;">
<div class="css-hvudvc eo18oon8"><span class="css-1btvv3a eo18oon1"><span>Drag and drop files here or </span> <button tabindex="0" type="button" class="css-uro7iq eo18oon0"><span>browse files</span></button></span></div><input
id="file_upload_File Upload" tabindex="0" type="file" multiple="" autocomplete="off" style="position: absolute; inset: 0px; opacity: 1e-05; pointer-events: none;">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Notes" data-client-type="text" id="PRPO0n2" class="css-1e3khfm ef83ajd0"><label for="text_box_Notes" data-client-id="label_Notes" class="css-1xl1v40 ekxsfat0">Notes</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Notes" data-client-id="text_box_Notes" data-client-type="" name="PRPO0n2" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Submitter Email" data-client-type="text" id="aONvQAp" class="css-1e3khfm ef83ajd0"><label for="text_box_Submitter Email" data-client-id="label_Submitter Email" class="css-1xl1v40 ekxsfat0">Submitter Email<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Submitter Email" data-client-id="text_box_Submitter Email" data-client-type="EMAIL" name="aONvQAp" maxlength="4000" class="css-1p0590h e1407lhe0"
value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Submitter Name" data-client-type="text" id="3m1EX1W" class="css-1e3khfm ef83ajd0"><label for="text_box_Submitter Name" data-client-id="label_Submitter Name" class="css-1xl1v40 ekxsfat0">Submitter Name<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Submitter Name" data-client-id="text_box_Submitter Name" data-client-type="" name="3m1EX1W" maxlength="4000" class="css-1p0590h e1407lhe0" value="">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Divider" data-client-type="divider" class="css-1e2fy0l e14sboee0">
<hr data-client-id="Divider" class="css-1xs1ymt e14sboee2">
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="email_receipt_section">
<div data-client-id="container_email_receipt" data-client-type="divider" class="css-1e2fy0l e14sboee0">
<hr data-client-id="email_receipt" class="css-1xs1ymt e14sboee2">
</div>
<div class="css-1gl0c9l excyp8g0"><label class="css-1y93uaa excyp8g1"><input data-client-id="email_receipt_checkbox" name="EMAIL_RECEIPT_CHECKBOX" type="checkbox" class="css-1czgm8r excyp8g2" value="false"><span>Send me a copy of my
responses</span></label></div>
</div>
</div>
<div class="css-1ock8o4 e1xpzprc2"><button data-client-id="form_submit_btn" disabled="" type="submit" value="submit" class="css-oltpmt e1xpzprc0"><span>Submit</span></button></div>
<div data-client-id="footer" class="css-ybae4b e8i4qwl0">
<div class="css-1kw6mnl e8i4qwl1">
<div class="css-qoiejo e8i4qwl3"><span>Powered by
</span><a target="_blank" href="https://www.smartsheet.com/platform?s=154" rel="noopener noreferrer" data-client-id="footer_poweredBy" aria-label="logo" class="css-a7ff3e e8i4qwl2"><svg role="img" xmlns="http://www.w3.org/2000/svg" version="1.1" width="80" height="35" viewBox="0 -55 406 179" style="margin-top: 2px; margin-left: 5px;"><title id="smartsheet-modern-logo-light">Smartsheet Modern Logo On Light</title><path fill="#003059" d="M85.4,29.7c-0.8-0.9-1.7-1.7-2.8-2.3c-1.2-0.6-2.6-1-4-0.9c-1.4,0-2.7,0.3-3.9,0.9c-1,0.5-1.7,1.6-1.6,2.7 c0,0.9,0.3,1.7,1,2.3c0.6,0.6,1.4,1.1,2.2,1.4c0.9,0.4,1.8,0.7,2.8,0.8l2.5,0.5c1.3,0.3,2.6,0.7,3.8,1.2c1.1,0.4,2.2,1,3.1,1.8 c0.9,0.7,1.5,1.7,2,2.7c0.5,1.2,0.8,2.5,0.7,3.9c0,1.7-0.4,3.3-1.2,4.7c-0.8,1.3-1.8,2.4-3.1,3.2c-1.3,0.9-2.8,1.5-4.3,1.8 c-1.6,0.4-3.2,0.6-4.9,0.5c-2.5,0.1-4.9-0.4-7.2-1.2c-2.2-1-4.2-2.5-5.6-4.6l4.8-3.9c1,1,2.2,1.9,3.4,2.7c1.4,0.8,3,1.2,4.6,1.2 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Statement of Account Form | EMEA Please submit your current Statement of Account for all open freight & customs invoices billed to GE Healthcare ➡ Only freight & customs invoices within EM6 scope should be included. Warehousing, (de-)Positioning, (de-)Installing, Labor charges are out of EM6 scope and must be invoiced separately ➡ PRO Number, BOL, Invoice Number, Invoice Date, Original Invoice Amount, Total Amount Due/Owed, Ship Date & Invoice Submission Date should be included in the statement. Invoice/PRO/BOL numbers should be in the same format as shown on the original invoice ➡ Statements should be consolidated regionally or at minimum on country/GEHC location level Should you have any questions, please contact us at GEHC_FREIGHTPAYMENT_AR@ge.com ~ GEHC Freight Payment Team Carrier Name* Select Caret IconCaret symbol Region* Select Caret IconCaret symbol Country* Please select all that apply Select Caret IconCaret symbol File Upload* Please upload your statement in excel (xlsx) format only. Drag and drop files here or browse files Notes Submitter Email* Submitter Name* -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Send me a copy of my responses Submit Powered by Smartsheet Modern Logo On Light Privacy Notice|Report Abuse