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Company Name *
Main Contact Name (First & Last) *
Type of Business *
Shipping Address *
Main Phone # *
Billing Address (If different than shipping)
Billing Phone # (If different than Main #)
Email(s) to send Invoices/Credits to (use ; to separate multiple emails) *
Email(s) to send Monthly Statements to (If applicable)  (use ; to separate multiple emails)
Your Email *
Purchase for Resale from Davis Distributing Co.
Under the provisions of the Retail Sales Tax and Use Tax Act, we, as vendors, are obligated to charge and collect such tax based on the sales price of all tangible personal property sold to purchasers in the State unless we have on file a certificate signed by you to the effect that such purchase are for resale or are otherwise exempt. We therefore enclose for your execution a Blanket Resale Certificate which when signed and returned to us will eliminate the tax charge which we would otherwise be compelled to make.
Your tax registration number as a retailer should be inserted in the space provided. If you have no retailer’s permit, but are exempt for some other reason, such other reason should be inserted in lieu of the permit number. The undersigned hereby certifies that he or she is a dealer in tangible personal property and that the tangible personal property which is purchased from the above will be purchased for the purpose of resale. This notice shall be considered a part of each order given unless otherwise specified.
State Sales Tax License Number (ex: 12345678-910-STC)(If creating a taxable account, then type n/a *
Authorization
The undersigned understands that in the event he or she uses, or consumes, the property so purchased otherwise than as above specified, he or she becomes liable for the tax imposed by law in such cases and will report said tax direct to the Tax Commission on his or her next regular sales and use tax return.
Name of Authorized Representative (Digital Signature) *
Today's Date *
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