CUSTOMER ONBOARDING FORM

Please complete this form to set up your new account with Nanosonics. Please note that the standard turn-around for account setup and being able to process orders is one week from receipt of this form.

Please note that this new account set up webpage is for customers located in the United States. If you are a new customer in Australia, please use this URL to set up a Nanosonics account. www.nanosonics.com.au/new-customer

Check box if you require a rush setup so you can place a consumable order?

Company Name*

Street Address*

City*

State*

Zip*

Billing Address that will be listed on the purchase orders.

Street Address*

City*

State*

Zip*

Billing Contact First Name*

Billing Contact Last Name*

Billing Contact Phone*

Billing Contact Email*

example@example.com

Duns Number

How would you like to receive invoices?

Email address to receive invoices*

example@example.com

Are some or all ship-to locations Tax Exempt?*

YesNo

If yes upload tax certificate*

Ship-to Addresses – Paste address(es) into text box.

Parent Company Name (if applicable)

Parent Company Address

Street Address

City

State

Zip

The Customer hereby makes this application for credit to Nanosonics, Inc. (“the Creditor”).

The Customer represents and warrants to Nanosonics Inc. (“the Creditor”) that this information is true and correct to the best of its knowledge. I/we acknowledge that the Creditor has informed us that certain information may be shared with credit providers. I/we acknowledge that I/we will provide additional information that may be requested by the Creditor as may be deemed necessary as part of the credit check process.

I/we the undersigned, accept the General Terms & Conditions of Sale of the Creditor which are provided with the sales quote and are displayed on the Creditor’s web site (www.nanosonics.us), or the mutually agreed terms and conditions (if different from the General Terms & Conditions of Sale of the Creditor). I acknowledge reading the Terms & Conditions of Sale. The terms may be varied with written notice. Credit is approved at the discretion of the Creditor and may be withdrawn at any time with written notice.

The Customer represents that, as of the date of this application, it is solvent, able to pay its debt as they come due and has not filed, nor is the subject of, any petition in bankruptcy or for any reorganization under any federal or state bankruptcy law. Should the foregoing representation become false at any time during the course of a business relationship between the Customer and the Creditor or while the customer owes any amounts to creditor, the Customer agrees to immediately notify the Creditor of all facts surrounding such occurrence.

This document must be signed and dated to enable processing. By entering name position and date, the signer is providing digital approval of the above agreement and data provided by the signer.

Acceptance by authorized person(s) / director(s) / proprietor:

Name*

First NameLast Name

Position*

Digital Signature*

Date*

Email*

example@example.com

Phone*

If you are a client of GHX, would you like to use GHX for ordering, invoicing, or confirmations?

Yes

Select which GHX options you would like to use?

810850855856

Please tell us which trophon devices you presently use so that we can better serve you:*

trophon® EPRtrophon®2trophon® EPR and trophon®2None

Upload your W9 and/or Tax-Exempt Certificate, if applicable

I would like to receive information and updates about Nanosonics' products, services, events and promotions by email.

I agree

I have read, understood and agree to the Privacy Statement*

I agree

Click here to read the Privacy Statement

I have read, understood and agree to the Terms and Conditions of Sale*

I agree

Click here to read the Terms and Conditions of Sale