Firm Name_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I hereby certify, That I hold valid seller's permit number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Issued pursuant to the Sales and Use Tax Law: that I am engaged in the business of selling
Type of Business_______________________________________________________________________
that the tangible personal property described herein which I shall purchase from Shinoda Design Center will be resold in the form of tangible personal property; PROVIDED, however, that in the event any of 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 uderstood 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___________________________________________________________________________
Use of Purchase, Check One:
___ Resale ___ Display (Taxable)
Print Name________________________________________ Title_________________________ Mail or fax this form with a copy of your business and/or resale license to:
601 W Dyer Road
Santa Ana, CA 92707
Phone (714) 541-4444
Fax (714) 541-0282