Government Form

Entity Name

Government type

Government

Military

Public Schools

College/University

Phone

Fax

Your Web Address

Billing Address

Address (billing)

City

State

Zip

Shipping address (If different) :

Address (shipping)

City

State

Zip

Purchasing Contact:

Name

Accounts Payable Contact:

Name

Email to Receive Invoices:

Resale Tax certificate number. (California, Florida, Missouri Only) Provide Copy

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Title

Date

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