Certificate of Resale Form

I HEREBY CERTIFY:

I hold a valid seller's permit number (please enter number below if you have one):
I am engaged in the business of selling the following type of tangible personal property:

I will resell the item(s) listed below, which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each item's purchase price or as otherwise provided by law.

This certificate is for the purchase from Imperial Media Services, Inc. of the item(s) I have listed below.
Description of property to be purchased for resale:

For Your Information: A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is more.

Business Address
Street: APT/Suite:
City: State: CA Zipcode: