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If you reside in the state of Washington, please fill out this form and return it to us via mail or fax, before (or with) your first order: Phone: 1 (800) 366-2156 *** Fax: 509-838-2602
2. Name of Buyer/Business__________________________________________________________ 3. Address of Buyer _______________________________________________________________ Home Phone (______) ___________________ Business Phone (______) ___________________ 4. Buyers UBI / Revenue Registration #___________________ State (if not Washington)_________ Registered Name _______________________________________________________________ 5. Buyer is in the business of ________________________________________________________ 6. Types of items purchased for resale _________________________________________________
I (the buyer) certify that I am purchasing the items listed on line 6 (please check appropriate box(es): Names of people authorized to buy for the above-named firm under this resale certificate:
Authorized Signature ___________________________________________________________ Date ______________________________________________ Title _______________________________________________For office use only: Effective through date (not to exceed 4 years) _________________________________
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