Tax-Exempt Certification Form (for CA, CO, MI, NC, and WA only)

Even though we are a wholesale company, due to retail regulations across the USA, Pursell Manufacturing will need to collect resale licenses or sales tax exemption forms on wholesale orders. Some states may require Tax-Exempt Certificates along with your order in order for us not to charge sales tax, while other states require us to just to document your status. Reasons for exemption may include resale, charity, government, tribal, industrial or agriculture. This process is easy and will only take a minute, please fill out your organization’s address information and check the reason for your exemption and then submit. Once we have received your resale license or exemption certificate(s), your account will be updated. If you do not have sales tax exemption, your state may require us to collect sales tax, in such cases, one of our customer service representatives will call you back. Will call options are also available for pickup from you or a representative at point of purchase.

CA, CO, MI, NC, and WA have indicated that this certificate is acceptable as a resale/exemption certificate for sales/use tax, subject to the instructions and notes above. The issuing Buyer and the recipient Seller have the responsibility to determine the proper use of this certificate under applicable laws in each state, as these may change from time to time.

"*" indicates required fields

Issued to Seller*

Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

I certify that,*

Name of Firm (Buyer)

is engaged or is registered as a*

Wholesaler

Retailer

Manufacturer

Seller

Lessor

Other

If Other (Specify)

and is registered for sales/use tax with the below-listed states and cities within which Seller would deliver purchases to Buyer and that any such purchases are for wholesale, resale, or ingredients or components of a new product or service to be resold, leased, or rented in the normal course of business. Buyer is in the business of wholesaling, retailing, manufacturing, leasing (renting), or selling the following: Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.

Description of Business:*

General description of tangible property or taxable services to be purchased from the Seller:*

State of Registration*

Choose StateCACOMINCWA

Seller’s Permit, or ID Number of Purchaser*

I further certify that if any property or service so purchased tax-free is used or consumed by Buyer so as to make it subject to sales/use tax, Buyer will pay the tax due directly to the proper taxing authority when state law so provides or inform the Seller for added tax billing. This certificate shall be a part of each order that Buyer may hereafter give to Seller, unless otherwise specified, and shall be valid until canceled by Buyer in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.

Authorized Signature*

Owner, Partner, or Corporate Officer, or other authorized signer of Buyer)

Title*

Contact Name*

First Last

Contact Email*

Contact Phone

Upload your existing tax exemption certificate pdf below*

Accepted file types: pdf, Max. file size: 5 MB.

Additional Comments

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Questions? Please don’t hesitate to contact us at 888-487-8288.