Client Information Sheet (Page 2 of 3) in pdf

Client Information Sheet Page 2

Blanket Certificate of Exemption

STATE OF TEXAS LIMITED SALES, EXCISE AND USE TAX ACT

This is to certify that I hold Limited Sales Tax Permit # __________________________________________

Issued pursuant to the Limited Sales, Excise and Use Tax Act.

This is to further certify that all tangible personal property purchased from J. B. Parks Wholesale Florist,

Inc, as vendor on, or after June 25, 1997, (unless otherwise specified on the order), is exempt from the

Texas Limited Sales, Excise and Use Tax Act as being tangible personal property purchased for resale,

rental, lease or will become an ingredient or component part of, or consumed in a manufactured product of

tangible personal property produced for ultimate sale.

I further certify that I assume liability for payment to the State of Texas for any tax which may become

due if any tangible personal property so purchased is used in such manner as to render the sales subject to

the tax.

Date: ______________________

Name of Business: _____________________________________________________________

Addendum:

I hereby authorize J. B. Parks Wholesale Florist, Inc., to use a facsimile copy of my signature as

an original on my “Application for Credit” or on the “Client Information” sheet and on the

“Individual Personal Guarantee”.

_______________________________________________________________

___________________

Signature

Date

Please use the space below to copy the front of your Driver’s License

Client Information Sheet Page 2