Kawasaki Robotics (USA), Inc.
28140 Lakeview Drive, Wixom, MI 48393

Tel: (248) 446-4100

Fax: (248) 446-4200

www.kawasakirobotics.com

EMAIL COMPLETED FORM AND EXEMPTIONS AND OTHER DOCUMENTS TO AccReceivable@kri-us.com

CUSTOMER SETUP FORM
1 COMPANY INFORMATION
Full Legal Business Name/Entity
Doing Business As (if not legal name)Street/Number

Bill To Address
City

State/ProvinceCountry

Postal/Zip Code

Foreign Address (if non US customer, please add address here in proper format)

Street/Number

Ship To Address (if different)
City

State/ProvinceCountryPostal/Zip Code

Foreign Address (if non US customer, please add address here in proper format)

Company Contacts
NamePhoneFax

Phone

Fax

Main/Buyer
EmailName

Accounts Payable
EmailIf requested Credit limit is $50,000.00 or more two years financial statements may be requested.

Please select the appropriate choice from the provided drop downs. Also Kawasaki Robotics (USA), Inc. isregistered to collect and pay sales tax in several states if you are exempt from Tax in any state please provide
a copy of your Direct Pay Certificate, Resale Certificate or applicable Exemption Certificate. These can beemailed with this form to accreceivable@kri-us.com.

Tax will be added to all invoices

if we do not have form on file prior to invoicing, exemption can't be claimed post invoicing.
Additional Company Information# of Employees

Legal Form of Bus. -Choose One

Year Business EstablishedType of Business -Choose One

State of Incorporation

Taxable/Exempt -Choose One

FCD-0425
Implementation Date: 06/21/19

Annual Sales

Federal Tax ID#Website

Dun & Bradstreet #Page 1 of 3

Kawasaki Robotics (USA), Inc.
28140 Lakeview Drive, Wixom, MI 48393

Tel: (248) 446-4100

Fax: (248) 446-4200

www.kawasakirobotics.com

2 CUSTOMER REQUIREMENTS
Payment Terms

Initial Order Amount

Freight Terms

Estimated Annual Purchases

Kawasaki Contact/Salesman

Requested Credit Amount

3 PURCHASE DETAIL- Foreign Entities ONLY
Please complete each item and send supporting document as noted with the *.
1. Are you a Foreign Entity purchasing goods for use or resale to/in a Foreign country (other than USA)?
2. What country is your company registered in?
** Please send documentation proving your registration to do business in country listed above.
3. Will this purchase be resold to another foreign unrelated entity?
Please type Statement that you are Foreign Entity Using/Selling purchased goods to Non-US Entity

4 BANK REFERENCE
Bank Name

Phone #

Bank Rep/Contact NameFax #Bank Address

5 TRADE CREDIT REFERENCES (Please list Three)Company Name

Phone #

Contact NameFax #Company AddressCompany Name

Phone #

Contact NameFax #Company AddressCompany Name

Phone #

Contact NameFax #Company Address

FCD-0425
Implementation Date: 06/21/19

Page 2 of 3

Kawasaki Robotics (USA), Inc.
28140 Lakeview Drive, Wixom, MI 48393

Tel: (248) 446-4100

Fax: (248) 446-4200

www.kawasakirobotics.com

We (Customer) hereby apply for credit and affirm financial responsibility, ability, and willingness to pay invoices in accordance withagreed terms. Unless otherwise agreed, payment terms are Net 30 Days and begin from date of invoice. We agree topay a monthly late fee of 1% per month, 12% annual on all Invoices not paid within thirty (30) days/agreed terms. The above information
is warranted to be true and complete. We hereby authorize Kawasaki Robotics (USA), Inc. to verify and collect information on us
including but not limited to bank references, trade credit references, consumer and /or commercial credit reports. We agree
to pay all costs of collection and litigation on this account in accordance with the laws of the State of Michigan. If the buyer
is not a corporation, Kawasaki Robotics (USA), Inc. is authorized to obtain credit reports on the proprietors, partners or principles.
We agree that all decisions with respect to the extenstion or continuation of credit shall be in the sole discretion of Kawasaki
Robotics (USA), Inc..

Authorized Signature

DatePrinted Name

Title

Notice: The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race,color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract);
because all or part of the applicant has, in good faith, exercised any right under the Consumer Credit Protection act. The
federal agency that administers compliance with the law concerning this credit is the Federal Trade Commission, Division ofCredit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.

FCD-0425
Implementation Date: 06/21/19

Page 3 of 3