Customer Application


For any questions, please call 800.284.7357 or email us at sales@supplyside.com


Date:
Account Status:
Acc #: Date of Last Purchase:
Organization is:
Billing Information (Required)
* Legal Name Of Company:
Dba:
* Street Address (No P.O. Boxes):
* City, State, Zip:
* Phone:
Fax:
* E-Mail:
Shipping Information (If different from Billing)
Street Address:
City, State, Zip:
Resale Certificate Document
State of:
Name of Purchaser:
Address of Purchaser:
State Tax I.D. #:
I Hereby Certify: that I hold 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: Supply Side USA, Inc.,
32125 Solon Rd. Suite 200, Solon, Ohio 44139, will be resold by me in the form of personal property; provided,
however, that in the event any 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 the 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:
Signature of Purchaser or Authorized Agent:
Please Print Name:
Title:

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