Louisiana Resale Certificate

Do not enter your social security number on this form.
Louisiana Resale Certificate

Sales Tax Exemption Certificate for Purchases for Resale R.S. 47:301(10)
Name of Purchaser:*
As shown on the sales tax account
Sales Tax Account Number*
(10 digits)
Business Address:*

Address

Street Address Line 2

CityState

ZIP Code
Phone Number:*
Please enter a valid phone number.
Email Address:*
example@example.com
Purchaser’s Type of Business*
Description of purchaser’s business activity or items sold:*
I, the purchaser, certify that all materials, goods, merchandise, and services purchased from the seller named below are for resale as tangible personal property, either in the same form as purchased or to be added as a recognizable, identifiable, and beneficial component of a new product. I further certify that all tax-exempt purchases will be resold in the normal course of our business.

I understand that if I use any of the items other than for resale, I must pay sales tax at the time of use. If this purchase is later found to be subject to tax, I, the purchaser, assume full liability for the tax.
Seller Information

Sioux City Tarp, Inc.
5201 Harbor Drive
Sioux City, Iowa 51111
Any purchaser or agent who fraudulently signs this certificate without intent to use the taxable items for resale is subject to all the penalties provided for by Title 47 of the Louisiana Revised Statutes and collection will be pursued against the seller or purchaser for any taxes, penalties and interest due.
Signature*

Clear
Printed Name*
Title*
Date*

MonthDayYear
Date
May we text you at this number (no spam)?*

YesNo
Would you like us to create a tax-exempt online shopping account for you at siouxcitytarp.com (pending approval of this form)?*

YesNo
We’ll use the contact info from this form to create your siouxcitytarp.com account and text you login instructions.
We’ll use the contact info from this form to create your siouxcitytarp.com account and email you login instructions.
Should be Empty:

Do not enter your social security number on this form.

Louisiana Resale Certificate