Sales Tax Exemption Certificate

In the course of doing business, it may become necessary to produce a Blanket Sales Tax Exemption Certificate, to cover multiple states.

This will allow the business to satisfy their vendors, without having to produce an individual Sales Tax Exemption Certificate for each state.

Here is a Sales Tax Exemption Form that can be used to indicate in which states the business is tax exempt.

Feel free to reformat the text as needed.

From the State of: __ Alabama (AL) _ Illinois (IL) __ Montana (MT) __ Rhode Island (RI) __ Alaska (AK) __ Indiana (IN) __ Nebraska (NE) _ South Carolina (SC) __ Arizona (AZ) __ Iowa (IA) __ Nevada (NV) __ South Dakota (SD) _ Arkansas (AR) __ Kansas (KS) __ New Hampshire (NH) __ Tennessee (TN) _ California (CA) __ Kentucky (KY) __ New Jersey (NJ) _ Texas (TX) __ Colorado (CO) __ Louisiana (LA) __ New Mexico (NM) __ Utah (UT) __ Connecticut (CT) __ Maine (ME) __ New York (NY) __ Vermont (VT) __ Delaware (DE) __ Maryland (MD) _ North Carolina (NC) __ Virginia (VA) __ District of Columbia (DC) __ Massachusetts (MA) __ North Dakota (ND) _ Washington (WA) _ Florida (FL) __ Michigan (MI) _ Ohio (OH) __ West Virginia (WV) _ Georgia (GA) __ Minnesota (MN) __ Oklahoma (OK) __ Wisconsin (WI) __ Hawaii (HI) __ Mississippi (MS) __ Oregon (OR) __ Wyoming (WY) __ Idaho (ID) __ Missouri (MO __ Pennsylvania (PA)

Purchaser hereby certifies to the Seller, ___________, ___________________________________ that: 1. Purchaser holds a valid Registration or Permit Number See Attached List issued under the Retail Sales Tax Act of the State of See Attached List and expiring on ______________. 2. That the tangible personal property purchased on each order is purchased for: (MARK ONE) _ Resale without change in form _ To be incorporated as a material or component part of other tangible personal property to be produced for sale __ Others (describe and attach special certificate if needed) ____________________________________________________________________________ ____________________________________________________________________________ 3. General description of products to be purchased from the Seller: ____ ______________________________________________________________________________ 4. The undersigned purchaser further certifies that he will assume liability for payment of the tax if he uses or consumes the property herein purchased in such manner as to render the sale subject to tax. Purchaser Date ______________ (Company Name) Address _ _______________________ ______ __ _____ (Name and Street) (City) (State) (Zip) Phone ( ____________________________________________________________ Signed __________________________________________________ _______________ _______ (Signature and Title) (Print Signature Name)

Attach list of applicable states here, and indicate status and/or license #.

STATE REGISTRATION/PERMIT NUMBER

Arkansas (AR) Status/License No.

California (CA) Status/License No.

Florida (FL) Status/License No.

Georgia (GA) Status/License No.

Illinois (IL) Status/License No.

Nevada Status/License No.

North Carolina (NC) Status/License No.

Ohio (OH) Status/License No.

South Carolina (SC) Status/License No.

Texas (TX) Status/License No.

Washington (WA) Status/License No.