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):

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 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.

Print Name :

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)