The Undersigned hereby claims exemption to purchase of tangible goods from Pure Products, Inc. on or after (Date)_________________ and certifies that this claim is based upon the purchaser's proposed use of the items purchased, the activity of the purchaser, or both, as shown hereon (i.e. retail, veterinary practice, etc.):

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PURCHASER MUST STATE REASON FOR CLAIMING EXEMPTION


This certificate shall continue in force until revoked and shall be considered a part of each order given to the above named vendor unless the order specifies otherwise.

Purchaser's Name_______________________________________

Purchaser's Activity, i.e. Veterinarian, Groomer, Pet Supplies Retailer

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Purchaser's Address______________________________________________________

Signature and Title_______________________________________________________

Date Signed_____________________________________________________________

Sales Tax Certificate number or Tax Exempt Certificate Number________________