Company Name or Organization: __________________________________________________

Address: _____________________________________________________________________

I hereby certify that I hold a valid BC Certificate of Registration# _________________________

In order for us to reference your account, please provide one or both of the following:
          Sales order number (SO#):________________
                                Customer #:________________

The tangible personal property will be used for wholesale, resale, or as an ingredient or component part(s) of a new product to be resold, leased, or rented in the normal course of my business.

Do you wish to be tax exempt for all future orders?
Yes
No, I only want to be exempt for SO#___________

Description of property to be purchased:
Computer peripherals
Other, please specify _______________________

Date: ____________ 
Print Your Name: _______________________________________
Phone number: __________________________________________
Signature: _______________________________________________

Fax to: (626) 271 ��C 9403    Email to: taxforms@newegg.com