CNC Parts Department
Phone 888-FANUC-US (888-326-8287), option 211
Fax: (847) 898-5021
E-mail: cnc.parts@fanucamerica.com
New CNC Customer Please fill in the fields on this form using your computer, and submit the
form via email using the button at the bottom. You can also save a copy of
Information Form this form to your computer.
CUSTOMER INFORMATION / BILLING ADDRESS:
*Company Name:______________________________________________________________________________________
*Billing Address: ______________________________________________________________________________________
*City:______________________________ *State:___________ *Zip Code:___________ *County:_________________
*Phone:________________________ *Fax:__________________________ *Website:_____________________________
*Invoice & Statement Email: _____________________________________________________________________________
SHIPPING ADDRESS:
*Same as Billing Address: No Yes (if no, fill in shipping information)
Shipping Address (1): __________________________________________________________________________________
City:_______________________________ State:___________ Zip Code:___________ County:____________________
Shipping Address (2): __________________________________________________________________________________
City:_______________________________ State:___________ Zip Code:___________ County:____________________
COMPANY INFORMATION:
*Customer Type (select one): End User MTB Importer Dealer Retrofitter Service Co. Other
*Industries Served (e.g. Medical, Automotive, Aerospace, etc.):__________________________________________________
*Are your end products Military, Defense or Nuclear related?: No Yes
If you would prefer your quotation be sent immediately, please include your part number and quantity:
1. Part #: __________________________________________ Quantity: _____
2. Part #: __________________________________________ Quantity: _____
3. Part #: __________________________________________ Quantity: _____
*Will the items purchased be for resale?: No Yes
*Will you be exporting the items?: No Yes To what countries?:___________________________________________
CONTACT INFORMATION:
*Contact Name:___________________________________________________ *Title:______________________________
*Phone:_________________________ Fax:___________________________ *Email:_____________________________
Note: Return this form with any resale or tax exempt certificates to the fax number or email address at the top of the page. All new customers
are on COD terms, with the option to pay by major credit card, until total sales have reached $5,000 within a one year period. Once $5,000 is
obtained, you may request a credit application and apply for terms of Net 30.
Note: Fields with an “*” are required.
Do not fill in this section, for FANUC America only. This form will be sent back to you with your FANUC America account number.
Thank you for your business!
All rights reserved. ©2017 FANUC America Corporation PAA-026-EN_03_1705
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