Certificate of Sales Tax Status

We are required by law to collect sales tax for shipments which are taxable.

If you are not liable for such taxes, please use the reply form. This form must be accompanied by the appropriate Exemption Certificate, Resale Certificate, or Direct Payment Permit.

Company Name_________________________________________________________

Street Address___________________________________________________________

City___________________State________Zip_____________________________

Sales Tax Registration Number_________________________ State___________

Authorized Signature________________________Title__________________Date________

_____TAXABLE

_____TAX EXEMPT