To download the Credit Application and Tax Certificate show below, click on this link:
www.phillipsdistribution.com/CREDIT APPLICATION AND TAX CERTIFICATE.rtf
NOTE: The file is in Rich Text Format (RTF) and will work in any word processor.
CREDIT APPLICATION AND TAX CERTIFICATE
Business name: ___________________________
Mailing address: ___________________________
___________________________
___________________________
Telephone No: ___________________________
Fax: ___________________________
Email: ___________________________
Tax I.D. # or SS# ___________________________
(Tax I.D. # consists of exactly 11 digits)
Date Business was established: ___________________
Type of Business: ___________________________
Business is: Sole Proprietorship ______; Partnership ________ ;
Corporation________; SIC Code: ____________
Officers and Owners:
Name: _____________________________
Address: _____________________________
_____________________________
Phone: _____________________________
Name: _____________________________
Address: _____________________________
_____________________________
Phone: _____________________________
Name: _____________________________
Address: _____________________________
_____________________________
Phone: _____________________________
Supplier Credit References:
Name: _____________________________
Address: _____________________________
_____________________________
Phone: ____________________________
Fax: _____________________________
Name: _____________________________
Address: _____________________________
_____________________________
Phone: ____________________________
Fax: _____________________________
Name: _____________________________
Address: _____________________________
_____________________________
Phone: ____________________________
Fax: _____________________________
Name: _____________________________
Address: _____________________________
_____________________________
Phone: ____________________________
Fax: _____________________________
I hereby authorize the bank and supplier references listed in this credit application
to release to Phillips Distribution, Inc. of San Antonio, Texas, any credit information
concerning myself or my company, which may be required to establish my trade credit.
A photocopy of this authorization may be used.
Authorized Signature : _____________________________
Printed Signature : _____________________________
Date : __________________
Note on Sales Tax: If you claim an exemption from state sales tax, please fill out
the appropriate form. If you are a reseller of the merchandise to be purchased from us,
use the Resale Certificate, and be sure to include your 11 digit tax ID number (mandatory).
If you are not a reseller, but your use of the products is otherwise exempt
from state sales tax laws, you must fill out and sign the Limited Use Certificate.
Please
fill out one of these forms only if you know you are tax exempt under law.
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Certificate of Limited Use Sales Tax
To Seller: Phillips
Distribution, Inc.
3000 E. Houston St.
San Antonio, Texas 78220 The undersigned is in the business of buying and using food service, and/or packaging products in the manufacturing process. The undersigned has purchased or will purchase these
products from Phillips Distribution, Inc. The undersigned claims an exemption from payment of sales and use taxes for the purchase
of taxable items described as food service, and/or packaging products. Purchaser claims this exemption pursuant to Sections 3.300, 3.293, and 3.314, of the Texas Sales Tax Law, pertaining to tangible personal property used or consumed in or during the actual manufacturing process or fabrication of tangible personal property for ultimate sale, in that the use or consumption of the property in question is necessary or essential to the manufacturing, processing
or fabrication operation. This
certificate shall be considered a part of each order which we shall give. Purchaser Name: ___________________________
Address :
___________________________
___________________________ ___________________________
I understand that I will be liable for payment of sales or use taxes which may become due for failure to comply with the provisions of the state Sales Tax Code, or any Limited Sales, Excise, and Use Tax Act, Municipal Sales and Use Tax Act, Sales and Use Taxes for Special Purpose Taxing Authorities, County Sales and Use Tax Act, County Health Services Sales and Use Tax, The Texas Health and Safety Code, Special Provisions Relating to Hospital Districts, Emergency Services Districts, and Emergency Services Districts in counties with a population
of 125,000 or less.
Signature
of Purchaser (or Authorized Agent)
Title:
Date:_____________ This form does not require a tax identification number in order to be valid. Please do not send this form to the Texas Controllers Office. Please fax this form to Phillips Distribution at
(210) 227-5638.
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Certificate of Resale
To Seller: Phillips Distribution, Inc. 3000 E. Houston St. San Antonio, Texas 78220 The undersigned is in the business of buying and reselling food service, janitorial and/or packaging products. The undersigned has purchased or will purchase these products from Phillips Distribution, Inc. The undersigned hereby certifies that all tangible personal property purchased by him/her is for the purpose of resale and assumes the liability for payment of sales tax, Retailers’ Occupation Tax, Service Occupation Tax, Use Tax, or any other applicable tax with respect to receipts from the resale of this property to users or consumers. This certificate shall be considered a part of each order which we shall give. Purchaser Name: ________________________ Address : ________________________ ________________________ ________________________
__________________________________ Signature of Purchaser (or Authorized Agent)
Title: _____________________
Date: _____________________
Resale Tax ID No: (11 digits) : State: Please fax to: Phillips Distribution, at: (210) 227-5638.
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