Wholesale Application | Hollander Specialty Glass

Wholesale Business Profile

Business Name

Mailing Address Shipping Address

City State Zip Code

Business Phone Number Fax Number

Check–Type of Business

Corporation Partnership Sole Proprietorship State Inc.

Year Business Began? Email Website

Exemption Certificate

Texas Sales and Use Tax Permit Number

Out-Of-State Retailer’s Registration Number State of Issue

I, the purchaser named above, claim the right to make a non-taxable purchase for resale of the taxable items described below as they are for resale or they will become part of an item for resale.

Description of tangible personal property to be purchased

The purchaser will be liable for payment of the Limited Sales and Use Tax if the purchaser uses the tangible personal property in some manner other than the reason listed above and shall pay the tax based on the price paid for the tangible personal property.

What company would you call your major wholesale source?

What company would you call your secondary wholesale source?

I (we) understand that the information furnished on this page is for the purpose of qualifying my company as a legitimate wholesale purchaser & that the information provided is true and correct as stated.

This information will be used to help us qualify you as a legitimate wholesale purchaser and to direct pertinent information to you through our selective mailing list.

Signed Title

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