This form contains 27 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Description of Items to be Purchased
Description of items to be purchased Text
Enter a clear, concise description of the items being purchased or those listed on the attached order or invoice, including quantities, model numbers, and any distinguishing details as needed to identify the goods.
Form Actions
SaveAs1 Button
Clear Resale Certificate Side of Form Button
Clear Exemption Certification Side of Form Button
Items Being Purchased (for Resale) Description
Description of items being purchased for resale Text
Enter a clear description of the taxable items being purchased for resale (include item names, quantities, model or part numbers, and any distinguishing details or reference to an attached order/invoice).
Purchaser Business Activity / Items Normally Sold
Business activity or items normally sold Text
Enter a short description of the purchaser’s usual business activity or the types of items the purchaser normally sells (e.g., 'retail clothing', 'restaurant food service', 'electrical supplies').
Purchaser Information
Purchaser Name Text
Enter the full name of the purchaser, firm, or agency exactly as shown on the permit.
Purchaser Phone Text
Enter the purchaser's telephone number including area code.
Purchaser Address Text
Enter the purchaser's street address, P.O. Box, or route number.
City, State, ZIP Text
Enter the purchaser's city, state, and ZIP code for the address provided above.
Texas Sales and Use Tax Permit Number Number
Enter the purchaser's Texas Sales and Use Tax Permit number.
Max length: 11 characters
Out-of-state Retailer Registration / Mexico RFC Text
Enter the out-of-state retailer's registration number or the Federal Taxpayers Registry (RFC) number for retailers based in Mexico. Fill only if 'City, State, ZIP' shows an out-of-state address or is in Mexico.
Depends on: City, State, ZIP
Purchaser name (firm or agency) Text
Enter the full legal name of the purchaser, firm, or agency as it should appear on the tax exemption certificate.
Address (Street, P.O. Box or Route number) Text
Enter the purchaser’s mailing or street address, including street number, P.O. Box or route number and any apartment, suite, or unit information.
Phone (Area code and number) Text
Enter a daytime contact phone number for the purchaser including the area code and any extension if applicable.
City, State, ZIP code Text
Enter the city, the state (postal abbreviation is acceptable), and the ZIP code for the purchaser’s address.
Purchaser Signature Details (Title and Date)
Purchaser Title Text
Enter the purchaser's job title or authority (for example, Owner, Manager, Partner, or Authorized Agent) who is signing the certificate.
Purchaser Signature Date Date
Enter the date when the purchaser (or authorized representative) signed this resale certificate.
Purchaser Title Text
Enter the signer’s job title, position, or authority within the purchasing organization.
Purchaser Signature Date Date
Enter the date the purchaser (or authorized representative) signed the certificate.
Reason for Exemption Claim
Reason for Exemption Text
Enter the purchaser’s detailed explanation of why the purchase is exempt from Texas sales and use tax, including any applicable statute, exemption code, or specific circumstances that support the claim.
Seller Information
Seller name Text
Enter the full name of the seller or business from whom the purchaser is claiming a non‑taxable resale purchase.
Seller street address Text
Enter the seller's street address, P.O. box, or route number for the seller named above.
Seller city, state, ZIP code Text
Enter the city, state and ZIP code for the seller's address entered above.
Seller name Text
Enter the full name of the seller or selling business from which the purchaser is claiming the exemption.
Seller street address Text
Enter the seller's street address, P.O. box, or route number for the seller listed above.
Seller city, state, ZIP code Text
Enter the seller's city, state and ZIP code associated with the seller address provided.