Mella Wholesale Account Application Form

Business Name *

Phone: *

Area Code Phone Number

Sellers Permit Number: *

Please make sure you are submitting a SELLER's PERMIT number issued by your States Dept of Tax and Fee Administration. NOT your EIN number (employee identification number). Thank you!

E-mail: *

Website: *

Shipping Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Trading since

Month Day Year

Type of Business *

Internet Bricks and mortar Wholesale

Description

I am engaged in the business of selling the following type of tangible personal property

Full Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Description of property to be purchased for resale

Please describe here

This certificate is for the purchase from Mella, LLC of the item(s) I have listed in paragraph above.

YES NO

I will resell the item(s) listed above which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each items purchase price or as otherwise provided by law.

YES NO

I have read and understand the following: For Your Information: A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale certificate to avoid payment to the seller of an amount as tax. Additionally, a person misusing a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is greater.

I Confirm the Above

YES I Confirm

Comments

By submitting this form, you are agreeing to the terms above and requesting a wholesale account with The Mella, LLC. Wholesale accounts are for retail products sold to customers only.

Thank you for choosing The Mella, LLC

Wholesale Application Form

Business Representative Information