www.rubberstamps.net Wholesale Application Form

Organization Name*
Organization Description*
Organization Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact E-mail*
Certificate Signer's Name*
Certificate Signer's Title*
Order Number
if already placed
Organization Type*

EducationalNonprofitFarmerReligiousGovernmentOther
Sales Tax License #*
Expiration Date*

MonthDayYear
License expiration must be a future date. For license without expiration date, please input date 2 years from today.
Sales Tax License*

Choose File
Please upload a copy of your retail sales tax permit for our records. This is issued by the Department of Revenue (or equivalent) for your state (not an IRS document). Accepted filetypes: .pdf, .doc, .docx, .jpg, .gif, .png. Cancelof
Terms and Conditions

I certify that the information I provided is true and accurate. I understand that my tax-exempt status may not be used to make tax-free purchases of items or services which are not for an exempt purpose and that I will report and pay the Consumer Sales or Use Tax on tangible personal property or services purchased pursuant to a tax-exempt certificate and subsequently used or consumed in a taxable manner. In addition, I understand that I will be liable for the tax due, plus substantial penalties and interest, for any erroneous or false use of this certificate.
I agree with the Terms & Conditions
Applicant Signature*

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Applicant Name*
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