...........................................................................................................................................................................................

(Name of Purchaser)


...........................................................................................................................................................................................

(Address of Purchaser)


I HEREBY CERTIFY: That I hold a valid seller's permit No.......................................................... issued pursuant to the

Sales and Use Tax Law; That I am engaged in the business of selling ............................................................................

........................................................................................................................................................................................ ;

that the tangible personal property described herein which I shall purchase from;  ......................................................

...................................................................................................................................................................................

will be resold by me in the form of tangible personal property; provided, however, that in the event any of
such property is used for any purpose other than retention, demonstration, or display while holding it for
sale in the regular course of business, it is understood that I am required by Sales and Use Tax Law
to report and pay tax, measured by the purchase price of such property or other authorized amount.

Description of property to be purchased; .........................................................................................................................

...................................................................................................................................................................................

....................................................................................................................................................................................

Date: ...........................  20..........           ......................................................................................................................
                                                                       (Signature of Purchaser or Authorized Agent)


                                                                   ...............................................................................................
                                                                (Title)











This form must be printed out, filled out and mailed to us if you are buying for resale 
and do not want to be charged sales tax.
This form must be complete, properly filled out, signed, MAILED TO US and the resale number must be verifiable 
by the State of California. We do e-mail the state to verify this information so please be sure the information 
is correct. Your order can not be process with out this information. 

If you are in a rush pay the tax and the state will reimburse you later.

Click here to check your resale #

Mail form to: 
Kelco Industries 
544 Lewelling Blvd. 
San Leandro, CA 94579
(Cut out address and use as mailing label)