WestRock Credit Application and Uniform Sales & Use Tax Exemption/Resale Certificate — Multijurisdiction Instructions

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This form contains 147 fields organized into 2 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
General
LEGAL FIRM NAME Text
Trade Style / DBA / Divisions Text
DATE Text
BILLING ADDRESS Text
PHONE Text
CITY Text
STATE Text
ZIP Text
FAX Text
PUBLICALY TRADED Text
CITY Text
STATE Text
ZIP Text
TAX ID NUMBER Text
INITIAL ORDER VALUE Text
ESTIMATED CREDIT LINE REQUIRED Text
SALESPERSON/CONTACT Text
DATE STARTED Text
PARENT COMPANY: NAME AND ADDRESS Text
A/P CONTACT NAME Text
A/P PHONE NUMBER OF CONTACT Text
A/P TELEPHONE EXT. AND EMAIL ADDRESS Text
YOUR ANNUAL SALES Text
ARE YOU AN AGRICULTURAL COMPANY? YES or NO Text
DOES YOUR COMPANY USE A PURCHASE ORDER (PS)? YES or NO Text
WHAT NAME WILL BE ON THE PURCHASE ORDER Text
NAME of BANK Text
BANK OFFICER Text
STREET ADDRESS Text
ACCOUNT NO. Bank Routing Text
CITY STATE ZIP Text
TYPE OF ACCOUNT Text
(PRINT) NAME AND TITLE (COMPANY OFFICER OR DIRECTOR) Text
SIGNATURE OF OFFICER OR DIRECTOR & DATE Text
WESTROCK SALES PERSON Text
PLEASE RETURN THIS FORM TO YOUR SALES REPRESENTATIVE Text
Premises_0 RadioButton
Premises_1 RadioButton
Exemption_Yes RadioButton
Exemption_No RadioButton
Public_Yes RadioButton
Public_No RadioButton
President/Owner Text
Authorized Officer Text
Ref 1 Text
Ref 1 Address Text
Ref 2 Text
Ref 3 Text
Other clarification Text
Invoice_E-mail RadioButton
Invoice_Postal RadioButton
Invoice_EDI RadioButton
Invoice_Other RadioButton
Text22 Text
Ag?_No RadioButton
Ag?_Yes RadioButton
Customer?_yes RadioButton
Customer?_No RadioButton
Type_Individual RadioButton
Type_LLC RadioButton
Type_Division RadioButton
Type_WO#20Sub RadioButton
Type_Corp RadioButton
Type_Partner RadioButton
Bank?_Check RadioButton
Bank?_Borrow RadioButton
Bank?_Savings RadioButton
Bank?_Secured RadioButton
Bank?_Unsecured RadioButton
Bank?_SBA#20Loan RadioButton
PO?_yes RadioButton
PO?_No RadioButton
DUNS Text
NAIC Code Text
Ref 2 Address Text
Ref 3 Address Text
Ref 1 Contact Text
Ref 2 Contact Text
Ref 1 E-mail Text
Ref 2 E-mail Text
Ref 3 E-mail Text
Ref 1 Phone Text
Ref 1 Fax Text
Ref 2 Phone Text
Ref 2 Fax Text
Ref 3 Phone Text
Ref 3 Fax Text
Issued to Seller Text
Address Text
Name of Firm (Buyer Text
Address Text
1 Text
2 Text
3 Text
Wholesaler CheckBox
Retailer CheckBox
Manufacturer CheckBox
Seller (California CheckBox
Lessor (see notes on pages 2─4 CheckBox
Other (Specify CheckBox
other Text
4 Text
Description of Business Text
General description of tangible property or taxable services to be purchased from the Seller [1 Text
General description of tangible property or taxable services to be purchased from the Seller [2 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_AL1 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_MO16 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_AR Text
State Registration, Seller’s Permit, or ID Number of Purchaser_NE17 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_AZ2 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_CA3 Text
State Registration Sellers Permit or ID Number of PurchaserNV Text
State Registration Sellers Permit or ID Number of PurchaserNJ Text
State Registration, Seller’s Permit, or ID Number of Purchaser_CO4 Text
State Registration, Seller’s Permit, or ID Number of PurchaserNM Text
State Registration, Seller’s Permit, or ID Number of Purchaser_CT5 Text
State Registration, Seller’s Permit, or ID Number of PurchaserNC Text
State Registration, Seller’s Permit, or ID Number of Purchaser_DC6 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_ND Text
State Registration, Seller’s Permit, or ID Number of Purchaser_FL7 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_OH Text
State Registration, Seller’s Permit, or ID Number of Purchaser_GA8 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_OK Text
State Registration, Seller’s Permit, or ID Number of Purchaser_HI4,9 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_PA Text
State Registration, Seller’s Permit, or ID Number of Purchaser_ID Text
State Registration, Seller’s Permit, or ID Number of Purchaser_RI Text
State Registration, Seller’s Permit, or ID Number of Purchaser_IL4,10 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_SC Text
State Registration, Seller’s Permit, or ID Number of Purchaser_IA Text
State Registration, Seller’s Permit, or ID Number of Purchaser_SD Text
State Registration, Seller’s Permit, or ID Number of Purchaser_KS Text
State Registration, Seller’s Permit, or ID Number of Purchaser_TN Text
State Registration, Seller’s Permit, or ID Number of Purchaser_KY11 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_TX25 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_ME12 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_UT Text
State Registration, Seller’s Permit, or ID Number of Purchaser_MD13 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_VT Text
State Registration, Seller’s Permit, or ID Number of Purchaser_MI14 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_WA26 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_MN15 Text
State Registration, Seller’s Permit, or ID Number of Purchaser_WI27 Text
Authorized Signature Signature
Title Text
Date Text
Instruction Page Freeform Text Field
Instruction Page Freeform Text Text
Enter the freeform instructional or explanatory text to appear on the instructions page (any plain text string).