Resale Tax Exemption Form
Name of Business*
Name of Purchaser*
Address of Purchaser
Zip Code
I HEREBY CERTIFY: That I hold a valid retail registration number.

Retail Registration number
Issued pursuant to the Kansas Sales and Compensating Tax Law; that I am engaged in the business of selling:
Item(s) selling:
That the tangible personal property described herein which I shall purchase from:
Name and Address of Seller
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 the Kansas Sales and Compensating Tax Law to report and pay tax, measured by the purchase price of such property.
Description of property to be purchased:
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Name of Purchaser or Authorized Agent
The KANSAS DEPARTMENT OF REVENUE has informed our company that we are required to carry a Resale Tax Exemption Certificate on all of our customer accounts. When filling out the above form, please make certain all the blank areas are completed and that you have typed your name and dated.
If you receive this notice and are not considered to be Tax-Exempt, please call me at 1-800-835-1010 or 316-263-8179 and I will correct this on your account.
Thank you for your time concerning this matter. Your prompt response will be greatly appreciated.