(Name of Purchaser)


(Address of Purchaser)

I 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:

that the tangible personal property described herein which I shall purchase from KWONG QUEST, LLC. will be resold by me in the form 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:

Date:


(Signature of Purchaser or Authorized Agent)

(Title)

Thank you!  Please print this page and fax ALL 4 forms PLUS a copy of your California Reseller Permit (5 forms total for California Resellers) to Benwin at 626.935.8891.

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