17050 Evergreen Place
City of Industry, CA 91745
Tel: 877-246-8294 Fax: 626-810-8313
Request for Tax Exempt
Dear Customer,

Due to California Tax Regulations, verification of a tax exempt permit is required. Please complete the form and fax it to (626)810-8313 as soon as possible. Please also provide a copy of your tax exempt permit. Thank you.


Company Information
Billing Address
Company :_______________________________

Contact Person: ___________________________

Phone #:_________________________________

E-mail: __________________________________

Address 1: ____________________________

Address 2: ____________________________

City :__________________________________

State:_______ Zip:_______________________

Tax Exempt ID : ______________________________________________________________________________





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