Company Name / (Name of Purchaser)

Complete address / City / State / Zip / (Address of Purchaser)

I HEREBY CERTIFY: That I hold valid seller’s permit No.

issued pursuant to the Sales and Use Tax Law; That
I am engaged in the business of selling: ;
that the tangible personal property described herein which I shall purchase from Prismatic Signs will be resold by me 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 understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount.
Description of property to be purchased:  Signs,displays and related items

Telephone Number:
              FAX Number:

Date: ___________________, 200___

_____________________________________
(Signature of Purchaser or Authorized Agent)

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