Billing Address

Your Name.............

Company Name.......

Address.................

City......................

State................... Zip Code...........

Country.................

Phone...................

Fax......................

e-mail address........

Website URL...........

Shipping Address Check if same as Billing Address

Name....................

Company Name.......

Address.................

City......................

State................... Zip Code...........

Country.................

Are these products being purchased for resale and will be resold in the ordinary course of business?
Yes
No
Are the products being purchased by a qualifying non-profit hospital, health care organization, or other qualifying exemption from sales tax?
Yes
No

Tax Exempt or EIN Number....

Please tell us about your business or non-profit:

I certify that the organization or business purchasing the product is exempt from sales tax for one of the above-mentioned exemptions, noted above. If requested, we will provide a copy of our resale certificate or non-exemption letter, as required.
Signed (Type Your Name)