Company Information
Company Name:
Address:
City / State / Zip:
Number of Years at Above Address:
Phone Number:
Fax Number:
Email Address:
Website Address:
Date Established:
Number of Employees:
Tax ID Number:
Resale License #:
Operations Information
Owner / President:
Social Security #:
Address:
City, State, Zip:
Phone:
Controller / Bookkeeper:
Purchasing Manager:
Banking References
Bank Name:
Bank Address:
Bank Contact:
Trade References
Company Name:
Address:
Contact:
Phone:
Resale Certicate
I HEREBY CERTIFY: That I hold a valid sellers permit NO. issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling AUTOMOTIVE PARTS AND SUPPLIES, that the tangible personal property described herein which I shall purchase from PARTS EXPRESS, INC will be resold by me in the form of tangible personal property; provided, however, that in the event of any such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of busines, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or authorized amount. Description of property to be purchased: AUTOMOTIVE PARTS AND SUPPLIES
Name of Purchaser or Authorized Agent:
Title:
Date:
Additional Comments: