RESALE CERTIFICATE

1. Name of Seller

2. Name of Buyer/Business

2.a. E-mail Address

2.b. Phone Number

3. Address of Buyer

City State Zip

4. Buyer’s UBI/Revenue Registration Number

5. Buyer is in the business of

6. Types of items purchased for resale

The buyer certifies that it is purchasing the items listed on line 6 (please check

appropriate box):

for resale in the regular course of business without intervening use.

for use as an ingredient or component part of a new article of tangible

personal property to be produced for sale,

as a chemical to be used in processing a new article of tangible personal

property to be produced for sale, or

for use as feed, seed, seedlings, fertilizer, or spray materials in its capacity

as a farmer.

The buyer acknowledges that it is solely responsible for purchasing within the

categories listed on line 6. The buyer acknowledges that misuse of the resale

privilege subjects the buyer to a penalty of 50 percent of the tax due, in addition

to the tax, interest, and any other penalties imposed by law.

Type Name

Name of Person Authorized By the Buyer to Sign the Resale Certificate

Effective Date through (Not To Exceed 4 Years)

Date Completed

Seller must maintain a copy. Please do not send to Department of Revenue.

Reference Rule and Statue (RCW 82.08.130 and WAC 408.20.102)

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