• Sales Tax Agreement Certificate of Exemption

  • The purchaser will be held liable for any tax and interest, and possible civil and criminal penalties imposed by the member state, if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-based exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption.

  • Enter the two-letter abbreviation for the state under whose laws you are claiming exemption *

  • If this certificate is for a Single Purchase Certificate Enter the related invoice/purchase order #

  • Purchaser's Tax ID Number:   *   
    State of Issue:   *   
    Country of Issue:   *   

  • If no Tax ID Number, enter one of the following:
    FEIN:      
    Driver's License Number:      
    State of Issue:         
    Foreign Diplomat Number:      

  • E. Reason for Exemption
        
          
          
          
          
           
           
                
          
            
            
          
     

  • I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.

    Print Name Here:      
    Title:   *   
    Pick a Date   

  • Clear
  • After submitting this form please return to the registration page to complete your application. 

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