Moss Sales & Service, Inc. Salina, Kansas - ON-LINE CREDIT APPLICATION FORM



PO Box 2807 Salina, KS 67402-2807 785.819.5474 www.mosssales.com moss@mosssales.com

SALES TAX EXEMPTION CERTIFICATE
Please print this form, complete it and then fax it to 785.823.2281

The undersigned purchaser certifies that the sale of tangible personal property or service by
Moss Sales and Service, Inc. of Salina, Kansas is exempt from sales compensating taxes
for the following reasons: (check appropriate exemptions):

__ Ingredient or component part
__ Consumed in production
__ Property purchased constitutes farm machinery or equipment, repair or replacement parts

or services for farm machinery or equipment, which will be used only in farming or ranching

__ Resale

Description of property or service purchased:
Agricultural equipment, parts and/or repairs

The undersigned understands and agrees that if the property or service purchased
is used other than as stated above, or for any purposes which is not exempt from
sales or compensating tax, the undersigned becomes liable for the tax.

State___________________________

Sales Tax Exemption # _________________________________________________

Company Name________________________________________________________

Address (include city, state, zip)__________________________________________

Authorized Signature _________________________________ Date_____________