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OR TYPE FULL LEGAL NAME, AND ALSO TRADE NAME (IF USED) MAIL TO DELIVERED TO (IF DIFFERENT) CITY STATE ZIP CODE CITY PHONE ZIP CODE DIVISION OR BRANCH OF (IF APPLICABLE) BUYER STATE NO. OF EMPLOYEES NUMBER OF YEARS IN BUSINESS UNDER PRESENT MANAGEMENT HAS BANKRUPTCY BEEN FILED WITHIN THE LAST 7 YEARS? YES ALL PURCHASES TAXABLE SALES TAX: TYPE OF BUSINESS NO IF YES, WHEN SOME PURCHASES TAXABLE ALL PURCHASES EXEMPT NOTE: PLEASE COMPLETE ATTACHED CERTIFICATE IF ANY PURCHASES ARE.

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