Resale Certificate Form

    1. Name of the Seller :
    2. Name of Buyer / Business :
    3. Address Of The Buyer :
    4. Buyer's Tax Registration Number :
    5. Buyer is in the business of :
    5. Types of items purchased for resale :

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

    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.

    Print Name :

    Effective Date (not to exceed 4 years) :

    Date Signed :

    Seller must maintain a copy. Please do not send to Department of Revenue.
    Reference Rule and Statute (RCW 82.08.130 and WAC 458.20.102)