I HERBY CERTIFY that I hold a valid seller's
permit No
Issued pursuant to
the States and Use Tax Law: that I am engaged
in the business of selling
That the tangible
personal property described herein will be resold by me
in the form of tangible personal property
PROVIDED however
that in the event any such property is used
for any other purpose
other than retention, demonstration, or display
while holding it for sale
in the regular course of business, it is understood
that I am required by sales tax and use tax
law
to report and pay the tax, measured by the
purpose of such property.
.. Date .....................................................................Signature
of Purchaser or Authorizing Agent
Important!!
If you are in the business of
reselling,
you will need to complete this
form
and mail it with your order
or
send by fax along with your
order,
It
must be Signed!