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Michigan Sales Tax Form

This certificate is invalid unless all four sections are completed by the purchaser.

To Download and Fax this form, click here and then fax to 810-629-8636.

Required fields are marked with *

SECTION 1
Check one of following :
One Time Purchase  Blanket Certificate
The purchaser hereby claims exemption on the purchase of tangible personal property and selected services made under this certificate from: United States Lighting Corp.
And certifies that this claim is based upon the purchaserís proposed use of the items or services, or the status of the purchaser.
SECTION 2
Items covered by this certificate :
All items purchased  Limit to the following items, items must be specific
SECTION 3
Basis for exemption claim:
Resale at Retail Sales Tax Registration Number :
*
Resale at wholesale-No number Required :
*
Industrial Processing :
*
Agricultural Production :
*

Non-Profit Organizations:

Please Select :
Federal Identification Number:

Federal Identification Number :
*
SECTION 4
Certification:
In the event this claim is disallowed, the purchaser promises to reimburse the seller for the amount of tax involved.
Purchasing Company :
*
Street Address :
*
City:
*
Country :
*

Signature (Name):
Title :
Date Signed :
October 17, 2017
_____________________________________
Area Code/ Telephone No :
A Blanket Certificate is valid for five years from the date of the signature unless an earlier expiration date is listed below Expiration date, if less than five years:
 
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