RESELLER CERTIFICATE Application Form State In Which You Are Applying Reseller Certificate *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBusiness Organization Type *SelectLLC Multi MemberLLC Single MemberS - CorporationC - CorporationLegal Name Of Company (As Per Articles Of Organization / Incorporation) *Nature Of Business *Ecommerce Whole Sale / RetailProfessional ServicesManufacturingReal EstateHealth CareOtherPlease Specify *Federal Employer Identification Number (FEIN)(assigned by the Internal Revenue Services For Reporting Federal Income Taxes)0 / 9Check Here If you Do Not Have An FEINList any Current Or Past 11-digit Taxpayer Number For Reporting Any Taxes Or Fees To The Comptroller Of Public Accounts *0 / 11Select The State Of USA Where This Company Was Formed *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingHome State Registration / File Number *Company Formation Date *If This Business Is A Corporation, Has it Been Involved In A Merger Within The Last Seven Years *YesNoShareholder Information ( List General Partner, Officer Or Managing Member )Full Name *Phone Number *Home Address *City *County (If known) *State *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *SSN /ITIN *0 / 9Percentage Of Ownweship *0 / 3Position Held *General PartnerOffice DirectorManaging MemberOther (Sole Member)Shareholder Information ( List General Partner, Officer Or Managing Member )Full Name *Phone Number *Home Address *City *County (If known) *State *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *SSN /ITIN *0 / 9Percentage Of Ownweship *0 / 3Position Held *General PartnerOffice DirectorManaging MemberOther (Sole Member)Mailing Address Of Company As Per ArticlesStreet Number And Name, P.O. Box Or Rural Route And Box Number *Suite / Apt. Number *State *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCity *County (If known)Zip Code *Mobile / Cellular Phone Number *Daytime Phone Number *Fax Number (Area Code And Number)0 / 10Business Website Address (If Any)Contact Person For Business RecordsFull Name *Email Address *Select *Same Address As Mailing AddressI Have My Own AddressStreet Address *Phone Number *Name Of Bank Or Other Financial Institution *Select *BusinessPersonalI Will Be Accepting Payments By Credit Card And / Or Through An Online Payment Processing CompanyMerchant Identification Number (MID) Assigned By The ProcessorEnter The Name Of The ProcessorLegal Name{text-1}Is This Place Of Business Operated From Your Home? *YesNoDo You Ship Or Deliver Items To Cities Or Counties Other Than Where You Have Your Place Of Business? *YesNoDo You Maintain A Distribution Center, Warehouse, Office Or Any Other Physical Location Where Business Is Conducted? *YesNoList The Location Of All Distribution Points, Warehouses Or Offices. (Do Not Include Locations That Are Considered A Place Of Business.)Street *City *State{select-7}Zip Code *Do You Have Any Representative, Agent, Salesperson, Canvasser Or Solicitor Who Operates Under Your Authority To Conduct Business At Your Selected Place Of Business, Including Selling, Delivering Or Taking Orders For Taxable Items? *YesNoFull Name *City *Street *State{select-7}Zip Code *Do You Own, Use, Sell, Lease Or Rent Tangible Personal Property Located At Your Selected Place Of Business? (This Includes Storing Machinery And Equipment) *YesNoDo You Provide Onsite Taxable Services At Customer Locations At Your Selected Place Of Business? *YesNoDo You Sell At Temporary Locations (Fairs, Trade Shows, Etc.) At Your Selected Place Of Business? *YesNoLocation And/Or Event Name (E.G., Canton First Mondays, State Fair In Dallas, Etc.) *Period In Attendance (E.G., First Weekend Of Each Month, Late October, Etc.) *Do You Have A Franchisee Or Licensee Operating Under Your Name Who Is Required To Collect Sales And Use Taxes? *YesNoDo You Have A Substantial Ownership In, Or Are Owned In Whole Or Substantial Part, By A Person Who Has A Business Location At Your Selected State For Business And Sells The Same Or Similar Line Of Products Under A Business Name That Is Similar To Your Business Name? *YesNoDo You Have A Substantial Ownership In, Or Are Owned In Whole Or Substantial Part, By A Person Who Maintains A Location In At Your Selected State For Business To Advertise, Promote Or Facilitate Sales, Deliveries Or Returns Of Your Products? *YesNoDo You Have Internet Or Mail Order Sales? *YesNoAre You A Marketplace Provider? *YesNoWill Your Anticipated Monthly Taxable Sales Exceed $8,000 Per Month? *YesNoEnter The Date That You Will Begin Making Sales? *Will You Operate This Business All Year? *YesNoList The Months You Will Operate: *Driver's License Number *Name Of Sole Owner, Partner, Officer, Director Or Member{name-3}Are You At Least 18 Yrs Of Age? *YesNoState *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUpload Signature *Choose FileNo file chosenDelete uploaded fileThe sole owner, ALL general partners, managing members, officers, directors or an authorized representative must sign. The representative must submit a written power of attorney.Date Of Signature *I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief. Send MessageSave as Draft Follow Us on Social Media Facebook-f X-twitter Envelope Linkedin Menu Home About Us Services In Pakistan Services In USA Contact Total Visitors: 1 8 6 5 1 9 USA 17W775 Butterfield Rd STE-123 Oakbrook Terrace, Illinois 60181 +18158650761 help@hq.legal PAKISTAN 108 Al-Hafeez HeightsGulberg III, Lahore 54000 +923004344622 help@hq.legal UAE 201-A Millennium Executive Tower Sheikh Zayed Rd, Dubai +971586821855 help@hq.legal