Dot Gibson Customer Info & Tax Exemption
(Print, Fill Out and Fax)

Company Name:_____________________________________________________________

Sole Proprietorship ( )                 Partnership ( )               Corporation ( )

Owner(s)_________________________    Buyers Name (1)___________________________

Owner(s)_________________________    Buyers Name (2)___________________________

_____________________________________     ____________________________________
Business Address                                                         Home Address

____________________________________     _____________________________________

____________________________________     _____________________________________
Area Code & Telephone # (Business)                       Area Code & Telephone # (Home)

_____________________________________
Area Code & Telephone # (Fax)                                  Years in Business_______________

Ship To: ______________________________   Bill To: _______________________________

               ______________________________                _______________________________

               ______________________________                _______________________________

This is to certify that all material, merchandise, or goods purchased by the undersigned
from Dot Gibson Publications is purchased for the following purpose:

______ Resale as tangible personal property.

______ To be exported for sale, use, or consumption outside the continental limits of the U.S.

______ Other: _______________________________________________________________

Certif. Number____________________ By: ________________________________________