Provide Tax Exemption Form or Resale Certificate *

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Supported format: JPG, JPEG, PNG, PDF

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The state that issued your exemption certificate. *

Please enter the tax exemption number issued to you by your state. If your state did not issue you a tax exemption number, please use the the first available to your organization: FEIN (federal employer identification number), Taxpayer Identification Number (TIN), or FDN (foreign diplomat number). *

Please select the Exemption Number type you entered in the question above. *

The effective date of your tax exemption. If you already have a valid tax exemption certificate issued by your state, then this should be today's date. If you have a certificate that will become valid on a future date, enter that future date here. *

If your exemption certificate has an expiration date, enter it here.

Please select the one that best describes your business activities. Most of our customers select "Manufacturing", "Retail Trade," or "Wholesale Trade. *

Select the option that identifies the reason for exemption. Nearly all of our exempt customers fall under 'Resale.' *

Please list the name of the entity, business or individual that was issued the exemption number you provided in question #2. If your business typically operates under a separate name (DBA), please provide that as well.

Customer Name *

Street Address

Street Address (cont'd)

City *

State *

Zip Code

Thank you for your submission!

We will verify your information with your state and then contact you regarding your tax-exempt status. Please note that you are not considered tax-exempt with MosleyLane until you receive confirmation from us.

If you have any questions, click here to contact us!

Thank you for your submission!

If you have any questions, click here to contact us!

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