43921 Boscell Road , Fremont , CA 94538
Tel: (510)9331200 Fax: (510)9331201
(Company Name of Purchase)
(Address of Purchaser)
HEREBY CERTIFY:That I hold valid seller's permit No.
issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling computer components that the tangible personal property described herein which I shall purchase from ATACOM INC will be resold by me in the from of tangible personal property; provided, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount.
Description of property to be purchased: _____________________________________
(Signature of Purchaser or Authorized Agent)