Open an account online at www.petra.com/application RAPID RESPONSE PROGRAM CREDIT APPLICATION, Page 3 TO TAKE ADVANTAGE OF PETRA’S RAPID RESPONSE PROGRAM, PLEASE COMPLETE ALL FIELDS. MULTI-STATE SALES TAX EXEMPTION AND RESELLER CERTIFICATE Any modification to this certificate renders it null and void. VENDOR: Petra Industries, LLC Address: 2101 S. Kelly City: Edmond State: OK Zip Code: 73013 Purchaser: Address: City: State: Zip Code: Is engaged as a: Wholesaler Retailer Manufacturer Lessor Other (specify)_______________ Is registered and/or identified with the below listed cities and/or states within which Customer's firm would deliver purchases from Petra and that any such purchases are for wholesale, resale, ingredients or components of a new product to be resold, leased, rented or used in the normal course of business. Customer is in the business of wholesaling, retailing, manufacturing, leasing (renting) the following: General Description of Business:_____________________________________________________________________________________ General Description of products to be purchased from the seller:__________________________________________________________ Effective Date of Certificate:_ _______________________________________________________________________________________ List Registration, Identification, Direct Payment Permit # or Exemption # for each state the form applies. If state is not listed, a copy of current tax form is required! Alabama: __________________ Arizona: ___________________ Arkansas: __________________ California: __________________ Colorado: ___________________ Connecticut: __________________ Dist. of Col.: __________________ Florida: ___________________ Georgia: __________________ Hawaii: __________________ Idaho: ___________________ Illinois: __________________ Iowa: __________________ Kansas: ___________________ Kentucky: __________________ Maine: __________________ Maryland: ___________________ Michigan: __________________ Minnesota: __________________ Missouri: ___________________ Nebraska: __________________ Nevada: __________________ New Jersey: ___________________ New Mexico: __________________ North Carolina: __________________ North Dakota: ___________________ Ohio: __________________ Oklahoma: __________________ Pennsylvania: ___________________ Rhode Island: __________________ South Carolina: __________________ South Dakota: ___________________ Tennessee: __________________ Texas: __________________ Utah: ___________________ Vermont: __________________ Washington: __________________ Wisconsin: ___________________ Customer further certifies that if any property is purchased tax-free, and then is used or consumed by the Customer as to make it subject to a sales or use tax, Customer will pay the tax due direct to the proper taxing authority when state law so provides or informs Petra for added tax billing. This certificate shall be part of each order which Customer may hereafter give to Petra Industries, LLC, unless otherwise specified, and shall be valid until cancelled by Customer in writing or revoked by the city or state. Exemption Claimed: Federal Government Exempt Organization State and Local Government Direct Payment Permit Resale Other (specify)_________________ Under penalties of perjury, Customer swears or affirms that the information on this form is true and correct as to every material matter. __________________________________________________ _ __________________________ ________________ Customer’s Authorized Signature Title Date (Owner, Partner, or Corporate Officer) Phone: 1-866-719-6292 • Fax: 1-866-604-7288 • www.petra.com
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