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"Lighthouse Man"

Wholesale Application

Company Name:

Address:

City: State: Zip:

Telephone #: Fax #:

Email: Website Address:

Total Years in Business: Years at this location:

Type of Business: Proprietorship Partnership Corporation

Tax ID #:
You must also fax us a copy of your business license to 570-523-0813

Contact Name: Contact Phone:

I, the purchaser named above, claim the right to make non-taxable purchases for resale of the taxable items available to me through Kevin’s Custom Crafts. I hereby certify that this merchandise is purchased for resale and I understand that if I make any use of the item(s) other than retention, demonstration, or display while holding it for sale, lease or rental, I must pay sales tax on the item of use based upon either the purchase price or the fair market rental value for the time period used. I further understand that it is a misdemeanor to give a Resale Certificate to a seller for taxable items which I know are purchased for use rather that resale, rental or lease.

IMPORTANT: READ CAREFULLY:
Applicant understands that if accepted as an account of Kevin’s Custom Crafts all orders will be subject to acceptance at its office at 340 Hoffa Mill Rd., Lewisburg, PA 17837, and at all terms and conditions current at the time of order acceptance. Prices, terms and special discounts may be changed without prior notice to the customer.
Applicant further agrees that if accepted as an account all orders will be deemed to have entered into Union County, Pennsylvania, shall be interpreted in accordance with the laws of the state of Pennsylvania. Applicants understand that payment must be made prior to shipment.
Applicant agrees to notify Kevin’s Custom Crafts in writing within ten days of any change in partnership, corporation or legal structure of applicant’s business and further agrees that applicant will continue to remain liable to Kevin’s Custom Crafts for any unpaid balance due.

Applicant is defined as the legal entity requesting an account.

Signed: Title: Date:

Upon completion of this application, we will provide you with an account number you will need to use when placing an order. If you have any further questions, please contact us.

The information in this form will only be used by "The Lighthouse Man". All information herein will be kept strictly confidential and will not be released or sold to any person or business with the exception of authorized law enforcement personnel for the purpose of payment collection