(xxx) xxx-xxxx (xxx) xxx-xxxx Type of Organization*: ---CorporationPartnershipSole ProprietorshipOther Name and Title of Person Requesting Credit*: Billing/AP Contact Name* Telephone Number*(xxx) xxx-xxxx E-mail for Invoices*: Material Purchased For*: ---ResaleManufacturingOther Resale Certificate #*:
(xxx) xxx-xxxx
If there are additional owners please enter their full name, full address and phone numbers in the field below:
Reference #1 (xxx) xxx-xxxx (xxx) xxx-xxxx
Reference #2 (xxx) xxx-xxxx (xxx) xxx-xxxx
Reference #3 (xxx) xxx-xxxx (xxx) xxx-xxxx