Input form regarding procurement of raw materials

Please fill out all required fields in the form below and click on "Confirm".

Basic information

★Please provide a brief description of the company you are proposing in Sections 1–13 below.
★Please put your informations into the essential matters（marked *）.

1.Company name*
2. Type of the company*
3.Zip Code**Please enter the zip code in half-width numbers.
4.Address*
5.Name of the person in charge*
First Name
Surname
6. Department of the person in charge
7. E-mail address**Please provide an e-mail address that can receive e-mails from a personal computer.
Re-enter for confirmation
8. Telephone number**Please note that we may contact you to confirm the contents.
*Please enter the telephone number in half-width numbers.
9. Fax number*Please note that we may contact you to confirm the contents.
*Please enter the fax number in half-width numbers.
10. URL of the company
11. Capital stock (in yen)*
12. Annual sales (in yen)*
13.Number of Employees*Please enter the number of employees in half-width numbers.
employees

Proposal content

★Please fill in the information about the products you would like to propose in Sections A–D below.
★Please put your informations into the essential matters（marked *）.

A.Product name*
B. Product category*
C.CAS No.**Please enter CAS Number with half-width numbers. If there is no CAS Number, enter "None".
D. Characteristics (standards, prices, supply capacity, packaging specifications, etc.)**You can enter up to 1000 characters.

★If you do not mind, please provide a summary of the manufacturer of the product you are proposing in Sections I–V.

Ⅰ.Name of the manufacturer
Ⅱ. Manufacturing place (Country)
Ⅲ. Manufacturing place (Address)
Ⅳ. URL of the manufacturer
Ⅴ. Main products

Handling of personal information

For details about the handling of personal information, please see our privacy policy.

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