Open Account Application

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Account Name DBA
Billing Address
City State Zip Code
Telephone Fax E-Mail
Buyers Name Title AP Name
Shipping Address
City State Zip Code
Type of Business
Sole Proprietor Corporation Partnership
Date Established Yrs in Business
Print Name Signature

I hereby certify: I hold a valid sellers permit, permit number :

issued pursuant to the Sales and Use Tax Law, that I am engaged in the business of selling furniture. That tangible personal property described herein which I shall purchase from Homey Design will be resold by me in the form of tangible personal property. Provided however; that in the event any 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 Sales and Use Tax Law to report and pay tax measured by the purchase price of such property. Description of Property to be purchased: Furniture.

Federal Tax ID#
Signature of Purchaser or Authorized Agent Date Date
Print Name of Purchaser or Authorized Agent Title

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