SALES TAX EXEMPTION AGREEMENT

Sellers Name: __________________________________________________ Employer ID Number: ____________________________________________ (xx-xxxxxxx) Valid NYS Certificate of Authority Number: ___________________________(xxxxxx) NYS Sales Exemption Number: _______________________________ (xxxxxxxxx) Address: ______________________________________________________ Phone: _________________________ Email: _________________________ I the purchaser at the Crooked River Co-op hereby certify that I am a reseller and can legally claim exemption from the payment of sales tax for the purchase of taxable items in NYS. I understand that if the items purchased are not used for resale that I am legally required by NYS Sales and Use Tax Law to report and pay sales tax on the items purchased at the Crooked River Co-op at the time of purchase. I also take full legal responsibility for any liabilities incurred for any reason as a result of not paying the sales tax on the items purchased at the Crooked River Co-op.

________________________________________________ Signature

__________________ Date

This agreement must be approved before seller can be exempt from paying sales tax at the Crooked River

Co-op. Once this form is filled out a purchase can be made but the sales tax must be paid and reimbursed after approval.

________________________________________________ Approved by:

__________________ Date