STEP 1 - Sales Tax Exemption Certificate

Please fill out, click display, print, sign and fax this form to: (800) 767-9722 before proceeding to Step 2.

For Multi-State or Single State Use
Issued to: ACM Technologies, Inc., 2535 Research Drive, Corona, CA 92882

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Company Name:

Address:    P.O. Box:

City:    State:    Zip:

Distributor  Wholesaler  Retailer  Other (explain)

Product or services rendered:

State:	Tax ID#:	State:	Tax ID#:
State:	Tax ID#:	State:	Tax ID#:
State:	Tax ID#:	State:	Tax ID#:

 
I further certify that if any property so purchased tax free is used or consumed by the firm as to make it
subject to a Sales or Use Tax we will pay the tax due direct to the proper taxing authority when the state
law so provides or informs the seller for added tax billing. This certificate shall be part of each order which,
we may hereafter give to you, unless otherwise specified, and shall be valid until cancelled by us in writing
or revoked by the city or state.

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I swear or affirm that the information on this form is true and correct as to every material matter.

Authorized Signature:

x_______________________   Date:_______
   Signature of owner/partner/corporate officer

Printed Name________________________________

Please click Print and Sign this page before continuing to Step 2

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