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Toll
Free (800) 742-4546 |
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____________________________ |
____________________________ ____________________________ E-Mail Address |
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__________________________ Business
Owners Name __________________________ Owners
Phone Number __________________________ State Sales
Tax Exemption Number |
Type of
Business ____________/_____________ Date
Established / Date Acquired by Owner _________________________ State of
Issue |
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_____ Credit Card ___ Mastercard, ___ Visa, ___ Discover
_________________________ Credit
Card Number _________________________ Expiration
Date _________________________ Name on
the Credit Card |
_____ Credit Terms NOTE:
Richlin Fabrics Credit Terms are Net 30
Days, With Approved Credit. Are
Purchase Orders Required? _____ Yes, _____ No _________________________ Names of
Authorized Buyers |
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Name of
Supplier _________________________ Address _________________________ City,
State & Zip Code ____________/____________ Phone
Number / Fax Number ____________/____________ Contact
Name / Your Account Number |
Name of
Supplier _________________________ Address _________________________ City,
State & Zip Code ____________/____________ Phone
Number / Fax Number ____________/____________ Contact
Name / Your Account Number |
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Name of
Supplier _________________________ Address _________________________ City,
State & Zip Code ____________/____________ Phone
Number / Fax Number ____________/____________ Contact Name / Your Account
Number |
Name of Supplier _________________________ Address _________________________ City,
State & Zip Code ____________/____________ Phone
Number / Fax Number ____________/____________ Contact Name / Your Account Number |
The information
contained herein is submitted by the undersigned for the purpose of obtaining
credit. The undersigned expressly agrees to make payment in full to Richlin
Fabrics for all purchases in accordance with Richlin Fabrics invoices (s). The
undersigned agrees to pay a reasonable attorney's fee and all other costs and
expenses incurred by Richlin Fabrics in the collection of any obligation of the
undersigned pursuant hereto. Applicant likewise agrees that if suit is
necessary to enforce collection of any past due amounts, that said suit may be
filed in Jackson County, Missouri, and any defense of improper venue for
collection of any accounts shall be in Jackson County, Missouri. This
application for credit, once accepted by Richlin Fabrics, shall become part of
every invoice to applicant and is incorporated herein.
Signature________________________________________________
Print
Name_____________________________________________
Title_____________________________
Date______________________
A SIGNATURE IS MANDATORY.
ATTENTION CUSTOMERS
PLEASE FILL OUT THE FORM FOR WHICH YOUR STATE REQUIRES
In order to comply with the majority of state and local sales tax law requirements, Richlin Fabrics must have in its files a properly executed exemption certificate from all of its customers who claim sales tax exemption. If Richlin Fabrics does not have this certificate, it is obligated to collect the tax for the state in which the property is delivered.
If buyer is entitled to sales tax exemption, buyer
should complete the certificate and send it to Richlin Fabrics at its earliest
convenience. If buyer purchases tax free for a reason for which this form does
not provide, buyer should send Richlin Fabrics its
special certificate or statement.
This form of certificate has been determined to be acceptable
to the following states when used in compliance with their laws:
California, Delaware, Florida, Hawaii, Indiana,
Kentucky, Louisiana, Mississippi, Montana, New Hampshire, New Jersey, New York,
North Carolina, Ohio, Oregon, Puerto Rico, Virginia
BLANKET CERTIFICATE OF
EXEMPTION
SALES TAX EXEMPTION FORM
The undersigned Vendee ____________________________________________ hereby certifies:
Address _________________________________________________
City, State, Zip ______________________________________________________
2. that it holds the sales tax
license or permit number(s) indicated below (list number(s) if applicable)
1. c For
resale, in the regular course of business, in the form in which the tangible
property is received.
2. c For use or consumption as a material, ingredient, or component part for incorporation into personal property produced for sale.
5a. c Sale to a church or
5b c other not-for-profit
organization, operated exclusively for charitable purposes
Other authorized exemption
(describe):__________________________________________________
This
certificate shall be considered a part of each order given by Vendee from and
after the effective date hereof, unless such order shall otherwise specify.
This certificate shall continue in full force and effect unless and until
revoked by the Vendee. The Vendee understands and agrees that if it uses and
property purchased tax-exempt under this certificate in any manner which would
no exempt the sale from sales tax, the Vendee becomes the user or consumer of
such property, and as such assumes liability for the sales tax and interest and
penalty thereon, if any.
State ________________________ License Number ____________________________
Date ________________________ Signature__________________________________
Federal Tax ID #____________________ Name, Title (print) _____________________________
Return form to: RICHLIN FABRICS,
This form of certificate has been determined to be acceptable
to the following states when used in compliance with their laws:
Alabama, Alaska, Arizona*, Arkansas, Colorado,
Connecticut, District of Columbia, Georgia, Idaho, Illinois**, Iowa, Kansas,
Maine**, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska,
Nevada, New Mexico, North Dakota, Oklahoma*, Pennsylvania, Rhode Island, South
Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington,
Wisconsin***, West Virginia, Wyoming
* Arizona and Oklahoma hold a seller liable for sales tax due on any
sales with respect to which an exemption certificate is found to be invalid,
for whatever reason.
** Illinois and Maine do not have an exemption on sales of property for subsequent lease or rental.
*** Wisconsin allows this certificate to be used to claim a resale
exemption only when the item will be resold in the same form. Wisconsin does
not permit this certificate to be used to claim any other type of exemption.
UNIFORM SALES & USE TAX CERTIFICATE
MULTIJURISDICTION
Issued to: RICHLIN
FABRICS Address
414 EAST 14th AVE.,
I
certify that
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Name of Firm (Buyer) |
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Street Address or P.O. Box
No. |
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City, State, Zip |
Is engaged as a registered
c Wholesale
c Retailer
c Manufacturer
c Lessor (*See note above)
c Other (Specify)____________
and
is
registered with the below listed states and cities within which your firm would
either deliver purchases to us and that any such purchases are for wholesale, resale,
ingredients or components of a new product to be resold, leased or rented in
the course of our business. We are in the business of wholesaling, retailing,
manufacturing, leasing (renting) the following:
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Description
of Business: |
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City
or State |
State
Registration or ID No. |
City
or State |
State
Registration or ID No. |
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I
further certify that if any property so purchased tax free is used or consumed by
the firm as to make it subject to Sales or Use Tax we will pay the tax due
direct to the proper taxing authority when state law so provides or inform the
seller for added tax billing. This certificate shall be part of each order
which we may hereafter give to you, unless otherwise specified, and shall be
valid until canceled by us in writing or revoked by the city or state.
General
description of products to be purchased from the seller: Fabrics,
Notions and/or Accessories.
Under
penalties of perjury, I swear or affirm that the information on this form is
true and correct as to every material matter.
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Authorized
Signature (Owner, Partner or Corporate Officer) |
Title |
Date |