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UNIVERSAL UNIFORM SALES TAX & USE TAX CERTIFICATE
Recipient: Best Balms Corporation, 133 E Main Street, Elmsford, NY 10523
I Certify That:
Name of Company(Individual)_____________________________________________
Address:___________________________________________
___________________________________________
I Am A: _____Wholesaler _____Retailer ______Manufacturer _______Seller(CA) ________Other
Who is registered with the particular state inserted below and will be doing or is doing business for wholesale, resale, retail of products, services or ingredients that will be resold, leased or otherwise transferred during the normal course of business. Our company, corporation or individual is in the business of wholesaling, retailing, manufacturing or leasing the following products, services or other.
Business Description__________________________________________________________________________________________
Description of Product ___________________________________________________________________
State___________________________________________________
Tax ID #, Permit or Registration_____________________________
I_____________________________________, further certify that if any product or service that is purchased tax free that is used , sold or otherwise I(We) agree to pay whatever Sales Tax or Use Tax is due & payable directly to the proper tax authority that has jurisdiction. I also agree that is my sole responsibility to inform the seller that such taxes are due and have been paid accordingly. I hold harmless the seller, Best Balms Corporation for any and all tax liability that I may incur. This certificate will serve to act as a binding document on the reseller, wholesaler, retailer, lessor or other unless canceled by Best Balms Corporation or revoked by the individual state who has jurisdiction.
Under penalty of perjury, I (We) swear that the information that I (We) have submitted on this form is accurate and correct and truthful
Authorized Signature__________________________________________
Title________________________________________________________
Date__________________________________
Please fax completed form to 914-347-7632 or Scan completed document and e mail to servicebestbalms@aol.com
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