SUPPLIER INFORMATION FORM SUPPLIER #

TO BE COMPLETED AND RETURNED TO REQUESTOR

ATTENTION AUTHORIZED SIGNER

Whether providing goods, raw materials to Fruit of the Loom, Inc., or any of our Subsidiaries, all suppliers need to complete this application. Our Subsidairies
include Union Underwear Company, Inc. d/b/a Fruit of the Loom, Russell Brands, LLC, and Vanity Fair Brands, LP (collectively, “Fruit”). Please complete this
supplier application form and return with a Completed W-9 or, for non-U.S. based Legal Entities, a W-8BEN-E attached.

NOTICE It is essential that you attach form W-9 or W-8BEN-E to this form. The IRS requires Fruit to withhold a portion of all payments made to your account
if the payments meet reporting requirements of form 1099 or form 1042-S. Failure to provide Fruit with form W-9 or W-8BEN-E will require Fruit to withold the
maximum amount.
PLEASE COMPLETE ALL FIELDS

MarK One Current Supplier X New Supplier

SUPPLIER LEGAL NAME SERVICIO ELECTRICO MECANICO INDUSTRIAL S DE RL DE CV

TAX ID, EIN OR S/S # 05019006507999

TAX DOMICILE

SUPPLIER MAILING ADDRESS BARRIO MEDINA 8 CALLE 8 AVENIDA S.E

SAN PEDRO SULA, CORTES.

CITY/STATE or PROVINCE SAN PEDRO SULA, CORTES

POSTAL CODE / COUNTRY

CONTACT NAME EDUARDO MEJIA eMAIL SEMI.HONDURAS@HOTMAIL.COM

PHONE 2553-1552 / 2557-5260
FAX
TYPE OF SERVICE OR PRODUCTS THE SUPPLIER IS PROVIDING

REBOBINADO Y MANTENIMIENTO DE MOTORES Y GENERADORES ELECTRICOS AC Y DC

PAYMENT INFORMATION
PAYMENT TERMS 30 DIAS *Company Standard is 30 days Credit

PAYMENT TYPE ( Mark one) CHECK X WIRE TRANSFER

We will make payments through electronic transfers only to Banco Ficohsa accounts.
If your company currently works with other banks, we can support by requesting the bank to open
a bank account with zero initial balances.
If you do not agree, the payment type will be made by check.
WIRE INSTRUCTIONS CHECK REMITTANCE

Bank Name Remit To SEMI S DE RL DE CV

Bank Address Address BARRIO MEDINA 8 CALLE 8 AVENIDA S.E
City,State,Zip
Province, Country City,State,Zip SAN PEDRO SULA, CORTES
ABA Routing Number Province,Country HONDURAS
SWIFT Code
IBAN Number
Acct # 1
TYPE OF ACCOUNT. CHECK OR SAVINGS

CURRENCY

Acct # 2
TYPE OF ACCOUNT. CHECK OR SAVINGS

CURRENCY

Full Account Name

E-mail Address(es) for Remittance / Wire Transfer
(ALL PAGES MUST BE COMPLETED IN FULL, SIGNED AND SEALED)

PURCHASE ORDER INFORMATION

(Please complete this form for each location producing goods or providing services.)

FACTORY/OFFICE NAME SERVICIO ELECTRICO MECANICO INDUSTRIAL S DE RL DE CV

MAILING ADDRESS
SEMI.HONDURAS@HOTMAIL.COM
CITY,STATE,ZIP/POSTAL CODE SAN PEDRO SULA, CORTÉS
CONTACT PERSON ALEX EDUARDO MEJÍA ZEPEDA
PHONE 9561-6884
EMAIL SEMI.HONDURAS@HOTMAIL.COM

SUPPLIER LEGAL NAME

Print or Type Name of Signer:

Title of Signer:

Date: 18 DE JULIO DE 2023 Supplier Seal: _______________________________

Section to be filled by Fruit of the Loom

REVISED BY: APPROVED BY: