Wholesale Account Application Form

This section is for wholesale buyers only.
There is a $300.00 minimum purchase for wholesale.
Password is made available after submitting forms.

To purchase wholesale we require a retail license or Sales Tax license issued by the State your company resides in.
Exception is given to companies residing in Delaware, Montana, Oregon, New Hampshire, and Alaska.
If this is you, then we accept an EIN number.

Registered Company Name*

Phone:*

Area CodePhone Number

State Resale Tax Number (Required)*

This is the number you use to pay Retail Sales Tax to your state.

E-mail:*

Website:*

Business Shipping Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Type of Business*

InternetWholesaleRetail

Preferred Payment

Bank transferVisa/Mastercard

STATE OF ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION
SALES AND USE TAX SECTION EXEMPTION CERTIFICATE
GR-53 & AR Code 26-52-517(b)(1), (e), and (f)

I hereby certify that I either hold or am the authorized representative of the holder of an Arkansas Sales/Use Tax Permit Number, or that I am a nonresident purchaser or the authorized representative thereof and hold a similar permit issued by my state and that this is a current and valid permit number, and that I am exempt from sales and use tax on the tangible personal property purchased from Flash Mountain Crystals.*

(You must enter EITHER an Arkansas Tax Exemption Number *OR* your state and tax number)

I further certify that if any tangible personal property purchased exempt under this certificate is withdrawn from stock or otherwise used, that I will report the tax due under Arkansas Sales/Use Tax Law and Rules.

By checking this box, you agree that the information you provided is true and accurate to the best of your knowledge. This checkbox (along with your typed name) also serves as an authorized signature on this form.

Agree

By checking this box, you are stating that you have read our Policies and agree to the Terms and Conditions.

Agree

Wholesale Application Form