Customer Registration Form

Are you a company that has never ordered from MISUMI?
Fill in the form below and click "Next" button.

If you would like to complete your registration quickly, and to use "Product Search" and "2D/3D CAD Download" only, please click HERE for simplified registration.
(Please note that “Online Quotation/Order” is not available by simplified registration)

Required Field

Main Contact Name

YOUR PERSONAL INFORMATION

User Name
First Name
Last Name
E-mail Address
E-mail Address
(Confirm)
 

Company Infomation

BILLING INFORMATION

Company Name for billing
Billing Address PIN Code
 
Phone No.
Fax No.
Billing Address Contact Person
  Person1 Person2
First Name
Last Name
Department
Ext No.
E-mail
Mobile
Phone No.
Financial Department
Financial Person Name
Contact Phone no

SHIPPING INFORMATION

Company name for shipping
Shipping Address PIN Code
 
Phone No.
Fax No.
Shipping Address
Contact Person
  Person1 Person2
First Name
Last Name
Department
Ext No.
E-mail
Mobile
Phone No.
Paid-in Capital
Country of Origin
PAN No.
ECC No.  (If ECC is not applicable, please mention so )
TIN No.
Excise Range
Excise Division
Excise
Commissionerate
CST No.

END-USE AND END-USER INFORMATION

Please, fill in this sheet to provide information on the end-use(s) and end-user(s) of Misumi's products that you have the intention to purchase. The definition of 'end-user' is as below*.
A-1. End-use information: Please describe the expected end-use for which Misumi's product(s) will be used.
Please describe the expected end-use for which Misumi's product(s) will be used.
(Please describe:  )
e.g. Automation machinery, Precision casting
A-2. End-use information. Will Misumi's product(s) be used for any of the following purposes?
1 Development, production, use, or storage of :
1.1 Nuclear, chemical and/or biological weapons (including equipments to disperse such weapons)
1.2 Missile and/or unmanned aircraft which has a transport range of at least 300 km
1.3 Nuclear fuel materials or nuclear raw materials 1.4 Nuclear reactors or related equipments and parts
Yes No
2 Research related to nuclear fusion or Production of heavy water
Yes No
3 Activity as below conducted by a military or defense agency or a party assigned by them.
a. Development or production of chemical materials
b. Development, production, use or storage of microorganisms
Yes No
4 Any military use other than above. (If yes, please describe in detail:  )
B. End-user information
1 Name of end-user (Please write down your company's name if it is the end-user.) 
2 Judging from any documents or recording media, does the end-user have ever conducted any of item 1 to 4 in A-2, End-use information?
Yes No
3 Judging from any information source, will Misumi's product(s) be used or brought in any of the following nations? : People's Republic of Korea (North Korea), Iran, Iraq, Libya, Afghanistan, Congo, Cote d'Ivoire, Lebanon, Liberia, Sierra Leone, Somali Democratic Republic (Somalia), Sudan, Eritrea.
Yes No
*Definition of 'end-user': Either 1 or 2 as follows:
1. A party which will use the relevant Misumi's product(s) in its in-house equipment or device.
2. A party which will use, assemble, or process the relevant Misumi's product(s) in an equipment or device to sell.
Date 25/11/2017
Your Name
Title, Division
Name of company or party

MARKET INFORMATION

Type of Business (multiple selection possible)
Press Die Making Mold/Die Making OEM Manufacturer Distributor/Trader
Press Die Stamping Mold/Die Injection Machine Maker Design only
  Mold/Die Casting    
What is your preferred mode of communication?
E-Mail FAX
What are your business hours & weekly off?
Business hours -
Weekly Off
How did you know about Misumi?
What kind of products do you expect to buy from MISUMI?
Please select your main served industry
Main Customers
 1 2 3
How many employees are there in your company?
How many Design Engineers are there in your company?
Annual Turnover (latest fiscal year)
Please select your business field
What is the main type of products manufactured by your company?
Please select capitalization of your compan
What sort of information do you want to receive from MISUMI?

Terms & Condition

I agree to the terms and conditions described on MISUMI Terms & Condistions
     
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