Form 373 - Wholesale Exemption Certificate
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1
2STATE OF DELAWARE
Form 373
DIVISION OF REVENUE
WHOLESALE EXEMPTION CERTIFICATE
Name of Seller
Check Applicable Box
Single Purchase Certificate
Address
City
State
Zip Code
Invoice No.
-
-
-
Invoice Date
Shipping Location
City
State
Zip Code
Blanket Certificate
-
Date and State of Incorporation
Employer Identification Number
-
-
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
City
State
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
*DF41314019999*
(Revised 12/26/13)
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Parent category: Financial