Your company name
*
Please use the name on your Mad Micas account.
Email associated with your Mad Micas account
*
We need this to properly apply your exemption.
Contact email (if different from above)
If tax certificate contact is different from buyer email.
Contact name
*
First Name
Last Name
Contact phone number
*
Please enter a valid phone number.
State of issuance
*
2 character state abbreviation
Year of expiration
*
Expires on 12/31 of year entered. If no expiration, enter 2100.
Upload your certificate
*
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