Multi-Jurisdiction Sales Tax Exemption Certificate
This form may be completed on-line, then must be printed, signed and faxed or mailed to
Weld Direct (see address below)
Company
Name:
Issued to:
Weld Direct Corp
Address:
3096
West Beaver St
City
Jacksonville,Fl 32254
State
/ Zip
Fax #
(904)
387-5419
Acct
# (if Known)
Type of Exemption - check one
Resale
Qualifying Farm Machinery
Non-Profit
Manufacturing
Qualifying Industrial Machinery
Government Agency
Processing
Leasing
Other - please specify
I certify that the above named company is registered with the
below listed state(s) and or cities within which Weld Direct Corp would deliver purchases
to us and that any such purchases are for wholesale, resale, ingredients or components of
a new product to be resold, leased or rented in the normal course of our business.
We are in the business of wholesaling, retailing, manufacturing, leasing or renting.
State / City
Sales Tax Exemption Number
Expiration Date
I further certify that if any property so purchased tax free is
used or consumed by the firm as tomake it subject to a Sales or Use Tax, wel will pay the
tax due direct to the proper taxing authority when state law so provides or inform the
seller for added tax billing. This certificate shall be part of each order that we
may hereafter give to you, unless otherwise specified, and shall be valid until canceled
by us in writing or revoked by the city of state.
Exemptions
Options: (choose one)
Blanket Certificate
Single Purchase Certificate
Specific Tax Exemption (must indicate
applicable exemptions at right
Wire / Rod
Safety Equipment
Other - please specify
I swear or affirm that the information on this form is true and
correct as to every material matter.
