Dear Supplier: Please fill in the first three pages of this form, including the following sections: • Supplier Address & Country Detail • Supplier Contact Details • Supplier Bank/Financial Information When finished, click “Submit to Mentor Graphics” and the form will be saved as an attachment in an email for you to send.All information is relevant to Mentor Graphics and must be completed. If any information is missing, the purchase order or payment will be delayed.

Supplier Address & Country Detail: *

*

*

Supplier Name:

Name 2 :

Name 3 :

Name 4 :

Address:

Address 2 :

Address 3 :

Address 4 :

City:

Name in English: (for JP only)

*

Post Code / Zip Code:

Province/County:

*

Country:

Region/State:

Remit to Address: If different than above address Remit To Street Address:

Post Code / Zip Code:

PO Box:

City:

Country:

Region/State:

Payment Terms:

Accept payment by credit card ?

No

Mentor Graphics standard payment terms are NET 60.

Payment terms negotiated with purchasing Supplier Contact Details:

Account Manager: *

Phone

Extension Fax Extension E-mail Accounts Receivable Contact: (If different from above)

Phone Extension Fax Extension *

E-Mail

Agreed Delivery Terms & Product information: *

Agreed Delivery Terms. (Incoterms 2010 DDP, CIF, EXW) (If you are a service provider, please select "N/A - no shipping required".)

Description of Incoterms Description of Goods or Service provided by Supplier:

N/A N/A - no shipping required

Supplier Financial Details: (To receive payment by wire/ACH your country specific bank details must be provided below. Incomplete bank details could delay payment.)

Bank Country Bank Name:

Bank Branch:

Bank Street Address:

Bank City:

Bank Account Name:

Instruction Key:

Control Key # Intermediate Bank Information: (If Needed) Bank Key (Routing Code, Sort Code, or ABA#): *

Bank Account #:

IBAN # (For Israel and Europe) Swift code (Bank Data): *

Currencies

*

VAT No | USt-ID Nr | TVA:

Tax ID Or SSN (for US and RU only)

ILS Israeli Shekkel PAN for India

KPP (for RU only)

Completed By: On behalf of: *

Mentor Graphics Contact:

*

Mentor Graphics Contact Email:

Submit to Mentor Graphics

For Internal Use Only Mentor Graphics Contact *

CCode

IL02 MG Dev. Ser. (Israel) Ltd

PurOrg

SR01 Southern Europe MGC

Click this box if you are issuing a shopping cart For Internal Use Only Mentor Graphics Purchasing *

Payment Methods

*

Search Term

*

Payment Terms (negotiated with supplier)

Explain Pay Terms if less than 45 (first four characters of supplier name in CAPS)

Recon.acct

310000

Sort Key

009 External doc.number

Cash Mgmnt Group VENDORS

If less than 30 days contact buyer

Submit to Purchasing

Submit to Vendor Master