Application Form for Supplier Registration

Notes

If you would like to become a new supplier to us, please complete the application form and send it to us.
We will review the information you have provided and contact you at a later date.
Please note that it may take some time to respond to your inquiry or we may not be able to respond.

This form is a procurement application form. For other inquiries, please complete the Inquiry Form and send it to us.
Regarding the handling of personal information at DaikyoNishikawa Corporation, please refer to our Privacy Policy.

Proposal Form

Corporate information

Company name※	Company name is required field.
Representative’s name※
Capital※	Capital is required field.
Annual sales※	Annual sales is required field.
Number of employees※	Number of employees is required field.
Line of business※	Line of business is required field.
Main products※	Main products is required field.

Contact information

Name of contact person※
Email address※	Email address is required field.
Address※	Address is required field.
Phone number※	Phone number is required field.

Customers/Supply items

Customers/Supply items※
Main customers/Main supply items※

Equipment owned

Equipment name/number※

Other

Other special notes/Public relations information

Confirm the information provided after agreeing to our handling and purpose of use of the personal information you entered.