***ATTENTION: If your business is located within Non-program cites, Apache Junction, Avondale, Chandler, Douglas, Flagstaff, Glendale, Mesa, Nogales, Peoria, Phoenix, Prescott, Scottsdale, Tempe or Tucson, you must list both city and state sales tax numbers on your exemption certificate form***

Choose form 5000A for reselling our product

Choose form 5000 for government entities, hospitals, Native American or other exempt organizations.

Instructions for 5000A –

• Completely fill out the Purchaser Information section. Remember, your Arizona sales tax number is your License number.

• Please sign, and date to validate this certificate.

Certificate 5000A

Instructions for 5000 –

• Completely fill out Purchaser’s information.

• If your certificate or exemption status renews annually, please adjust dates accordingly.

• Choose and check the box which Transaction Type best suits your business and provide required information – 1) Transactions with a business, 2) Transactions with Native American, 3) Transactions with Government, Health Care, or 4) Transactions with nonresidents.

• Check the Reason for Exemption box below.

• Please sign, and date to validate this certificate.

 Certificate 5000