FIRM NAME _____________________________________________________

 

I HERBY CERTIFY,

That I hold a seller's permit No. _____________________________________________________________________________

issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling

 

________________________________________________________________________________________________________

that the tangible personal property described herein which I shall purchase from:

 

     WESTERN PACIFIC DISTRIBUTORS           (WPD)                                                          

will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event any such property is used for

any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is

 understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such

property.

 

Description of property to be purchased: _____________________________________________________________________

 

______________________________________________________________________________________________________

 

Dated: _______________________ 20_________ Signature _____________________________________________________

 

at ______________________________________ By and Title __________________________________________________

 

Phone ___________________________________ Address ______________________________________________________

 

 

 

 

 

 

 

Please send all forms to: