ARIZONA RESALE CERTIFICATE

ARIZONA RESALE CERTIFICATE

ARIZONA FORM 5000A
This Certificate is to be completed by the purchaser and furnished to the vendor who shall retain it. Incomplete certificates must not be accepted in good faith.
SELLER INFORMATION
Seller*
Street Address*
City, State, Zip Code*
PURCHASER INFORMATION
Your Email*
example@example.com
Purchaser*
License number*
Street Address*
City, State, Zip Code*
I am engaged in the business of*
The property is purchased for resale and will be resold in the ordinary course of business.*
Description of the property being purchased*
Check Applicable Box*

Single Purchase CertificatePeriod (Range)
Start Date
Through (End Date)
CERTIFICATION
A seller that has reason to believe that the certificate is not accurate, complete or applicable to the transaction, may not accept the certificate in good faith and the seller will not be relieved of the burden of proving entitlement to the exemption. A seller that accepts a certificate in good faith will be relieved of the burden of proof and the purchaser may be required to establish the accuracy of the claimed exemption as provided in ARS § 42-5022. Subsequent use or consumption of the tangible personal property by the purchaser other than the sale in the ordinary course of business will subject the purchaser to the Arizona use tax. Willful misuse of this Certificate will subject the purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.

I print hereby certify that these purchases are for resale and that the information on this Certificate is true accurate and complete. Further, if purchasing as an agent or officer I certify that I am authorized to execute this Certificate on behalf of the purchaser named below
Your Name*
Signature of purchaser*

Clear
Date*

MonthDayYear
Date
Title*
Should be Empty:

ARIZONA RESALE CERTIFICATE

SELLER INFORMATION

PURCHASER INFORMATION

CERTIFICATION