Resale / Tax-Exempt Certificate

Uniform Sales & Use Tax Exemption / Resale Certificate. Complete the fields below to certify your resale or exemption status. Provide your state registration / seller’s permit number for each applicable state (Tennessee buyers: complete the TN row).

Seller

Issued to Seller

Seller Address

Buyer

Name of Firm (Buyer) *

Registered as *

If Other, specify

Buyer Address *

Buyer Email

Description of Business

General description of tangible property or taxable services to be purchased

State Registration Numbers

State 1

Registration / Seller’s Permit / ID No.

State 2

Registration / Seller’s Permit / ID No.

State 3

Registration / Seller’s Permit / ID No.

Add the state(s) in which you are registered and the matching permit / ID number.

Certification

I certify that the firm named below is engaged as indicated and is registered with the listed states, and that purchases are for wholesale, resale, or as ingredients or components of a new product or service to be resold, leased, or rented in the normal course of business. If any property or service purchased tax free is used or consumed so as to make it subject to Sales or Use Tax, we will pay the tax due directly to the proper taxing authority or inform the Seller for added tax billing. This certificate is part of each order unless otherwise specified and is valid until canceled in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.

I certify the above under penalties of perjury.

Authorized Signature (type full name) *

Title

Date