Form 373 - Wholesale Exemption Certificate
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STATE OF DELAWARE
DIVISION OF REVENUE
Print Form
WHOLESALE EXEMPTION CERTIFICATE
Name of Seller
Check Applicable Box
Single Purchase Certificate
Address
Zip Code
Invoice No.
Shipping Location
Zip Code
Invoice Date
Date and State of Incorporation
Employer Identification Number
Blanket Certificate
THE UNDERSIGNED CERTIFIES THAT:
1.
The purchaser’s employees and vehicles receiving the goods within Delaware are not
headquartered – or dispatched from within Delaware; and
2.
No portion of the goods received will be inventoried, warehoused, or otherwise come
to substantial rest within the State prior to ultimate delivery outside Delaware; and
3.
The purchaser has no business facility or goods on consignment or warehoused within
Delaware, if this is a blanket certificate.
Name of Purchaser
Address
Zip Code
Date and State of Incorporation
Employer Identification Number
Name of Business
Under penalties or perjury, I declare that I have examined this Certificate, including accompanying schedules
and statements, and to the best of my knowledge and belief it is true, correct and complete.
Date
Signature of Officer or Authorized Individual of the Purchaser
Title
Date
Signature of Officer or Authorized Individual of the Seller
Title
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Parent category: Financial