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New Company

This form must be completed in its entirety to be a valid exemption.

Purchasers are responsible for knowing if they qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide this exemption certificate (or the data elements required on the form) to a state that would otherwise be due tax on this sale.

The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state, if the purchaser is not eligible to claim this exemption.

Company Information

Company Name

Company Legal Name

Company Email

VAT/TAX ID

Legal Address

Street Address

City

Country

State/Province

ZIP/Postal Code

Phone Number

Company Administrator

Job Title

Email

First Name

Last Name

Reason for exemption. Please check the radio button that identifies the reason for the exemption and if applicable, enter your assigned ID# in the box that appears below the radio button after being checked.

Resale

Agricultural production

"Use your cursor to add your signature to the line below." I declare that I am exempt from paying sales tax on purchases from Mahaney Hardware, for the above reason, and I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.

Signature of Authorized Purchaser

This is a required field.