Trade Status Validation Form

TRADE STATUS VALIDATION FORM

Use this form to certify the trading and tax status of the submitting entity for the purpose of purchase, resale, tax exemption, or customs classification. The signatory certifies under penalty of perjury that the statements and documentation provided accurately reflect the entity's legal trade status and that the entity will notify the requester in writing of any change in status that would affect the accuracy of this certification.

1. Business / Vendor Information

2. Identifiers & Registration

3. Entity Type (select all that apply)

Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Government Entity Nonprofit / Tax-Exempt Organization Broker / Dealer Other:

4. Trade Status Declaration

Indicate the trade status being asserted for transactions with the requester. Check all applicable statuses and provide associated certificate numbers, issuing jurisdictions, and effective dates where required.

Reseller / Retailer (Resale certificate provided) Certificate/Reg. No.: Issuing State/Jurisdiction: Effective Date:

Tax-Exempt Organization Exemption Type / Code: Issuing Authority / No.:

Manufacturer Distributor / Wholesaler Importer / Exporter (provide customs classification documents) Taxable - No exemption claimed Other status:

5. Attachments & Supporting Documentation

Attach or provide reference to all documents that substantiate the claimed trade status. Check attached documents below and identify any documents to be provided upon request.

Resale Certificate Tax-Exempt Determination Letter Articles of Incorporation / Registration Customs / Import Documentation Other attachments:

6. Certification and Legal Acknowledgement

I hereby certify, under penalty of perjury and in accordance with applicable law, that the information provided in this Trade Status Validation Form and any attached documentation is true, correct, and complete. I further certify that the entity named herein is authorized to claim the declared trade status for purchases made from the requester, and that such status will remain in effect until revoked in writing. I acknowledge that the requester may rely upon this certification and that false statements may subject the signer and the entity to civil or criminal penalties and to liability for taxes, interest, and penalties.

The entity agrees to provide, upon written request, original or certified copies of any certificates, determinations, or governmental registrations supporting the asserted status. The entity also authorizes the requester to verify, where permitted by law, the validity of claimed certificates or registrations with issuing authorities.

The requester reserves the right to withhold tax collection or to collect applicable taxes should this certification be found invalid or insufficient under applicable law. The certifying party agrees to hold the requester harmless for reliance upon this certification in good faith.

7. Authorization

Company Name:

8. Verification Consent & Duration

By signing below, the authorized representative consents to verification of the declared status and acknowledges that this certification remains in effect until the earlier of (a) written revocation by the certifying party, or (b) expiration of any certificate or determination referenced herein. The requester may rely on this certification for transactions occurring while the certification is in effect.

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