Wholesale Reseller Certificate Form

Please review and verify the below information as well as fill in any remaining fields. This will be used to generate your state mandated Tax Exemption document for signature.

Name of Firm (buyer) *

First Name *

Last Name *

Title *

Email *

Address *

Address Line 1

Single Line Text

Address Line 2

City

State *

State

Single Line Text

Zipcode

Description of Business *

General Description of Products to be Purchased from Seller *

Clicking submit will generate and send your Tax Exemption Certificate to the email address previously provided for e-signature. Your HATH account will not be approved until this is completed.

Name

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