Sales Tax Agreement Certificate of Exemption

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 State*
Do you need to submit forms for multiple states?

NoYes (if yes, customer service will reach out after your approval to help finalize your account).
If this certificate is for a Single Purchase Certificate Enter the related invoice/purchase order # State
A. Name of purchaser*
Name of Business*
Email (In case we need to contact you)*
example@example.com
B. Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Purchaser's Tax ID Number:   Tax ID Number *
State of Issue:   State Abbreviation *
Country of Issue:   Country*
If no Tax ID Number, enter one of the following:
FEIN:   FEIN
Driver's License Number:   Driver's License Number
State of Issue:   State Abbreviation
Foreign Diplomat Number:   Diplomat Number
D. Purchasers Type of Business*

Accommodation and food servicesTransportation and warehousingAgriculture, forestry, fishing, huntingUtilitiesConstructionWholesale tradeFinance and insuranceBusiness servicesInformation, publishing and communicationsProfessional servicesManufacturingEducation and health-care servicesMiningNonprofit organizationReal estateGovernmentRental and leasingRetail tradeNot a businessOther (explain)
E. Reason for Exemption
Federal Government (Department)   Department
State or local government (name)   Name
Tribal Government (name)   Name
Foreign Diplomat #   Number
Charitable Organization #     Number
Religious Organization #    Number
Resale #    Number
Agricultural Production #    Number
Industrial Production/Manufacturing #    Number
Direct pay permit #     Number
Education Organization #     Number
Other (explain)   Explain
I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.

Print Name Here:
Title:   Title *
Date
Signature*

Clear
To sign, please click your mouse, hold, and drag your cursor to form your letters. Signature of Authorized Purchaser
After submitting this form please return to the registration page to complete your application.
Should be Empty: