MARATHON CREDIT APPLICATION
 November 17th, 2017  
     
COMPANY NAME
ADDRESS
TELEPHONE
EMAIL
CITY
STATE
ZIP CODE
     
         OFFICERS OR COMPANY OWNERS     TELEPHONE  
     
1.     Corporation
    Partnership
    Proprietorship
2.
3.
     
PLEASE SUPPLY THE NAMES OF THREE CREDIT REFERENCES: (Excluding Banks & Credit Card Companies)

1.
  NAME
 ADDRESS
CITY
STATE
ZIP CODE
 TELEPHONE
FAX
PERSON TO CONTACT
       

2.
  NAME
 ADDRESS
CITY
STATE
ZIP CODE
 TELEPHONE
FAX
PERSON TO CONTACT
       

3
NAME
 ADDRESS
CITY
STATE
ZIP CODE
 TELEPHONE
FAX
PERSON TO CONTACT
     
 TERMS:


Our terms are Net 30. A finance charge of 1 1/2% per month (18% per year) will be assessed on all invoices over 30 days old. Cost and reasonable attorney fees may be charged. Open accounts are not applicable on preproduced products.

        DATE
    
SIGNATURE


By submitting this form, I understand the terms and anticipate no difficulty in fulfilling these credit requirements.

TITLE

 

 
nebraska
department
of revenue
Nebraska Resale or Exempt Sale Certificate
for Sales Tax Exemption
FORM
13
NAME AND MAILING ADDRESS OF PURCHASER
NAME AND MAILING ADDRESS OF SELLER
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
City   State   Zip Code
City   State   Zip Code
Check Type of Certificate Single Purchase Blanket If blanket is checked, this certificate is valid
for three (3) years from date of issuance.
I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason:     Check One

Purchase for Resale (Complete Section A)
Exempt Purchase (Complete Section B)

Contractor (Complete Section C)

SECTION A — Nebraska Resale Certificate


Our purchase of
                                    Description of Item(s) Purchased

is a purchase for resale, rental or lease in the normal course of our business, either in the form or condition in which purchased, or as an ingredient or component part of other property to be resold.

I further certify that we are engaged in business as a:
        Wholesaler     Retailer     Manufacturer     Lessor

of
                Description of Product Sold, Leased, or Rented

and hold Nebraska Sales Tax Permit Number 01-
If none state reason

or Foreign State Sales Tax Number

SECTION B — Nebraska Exempt Sale Certificate

The basis for this exemption is exemption category   (appropriate categories)


If exemption category 2 is claimed, enter the following information:

Description of Item(s) Purchased
 Intended Use of Item(s) Purchased


If exemption category 6 is claimed, seller must enter the following information and sign this form below:

Description of Item(s) Sold
Date of Seller’s Original Purchase
Was Tax Paid when Purchased by Seller?
YES   NO
Was Item Depreciable?
YES   NO


If exemption categories 3 through 5 are claimed, enter the Nebraska Exemption Certificate number.


SECTION C — Contractors

I certify that we are engaged in business as a contractor operating under OPTION 1, and that we will collect and remit sales tax on the materials portion of our customer’s invoice.
Our Nebraska Sales Tax Permit Number is: 01-
OR
I certify that we are engaged in business as a contractor operating under OPTION 3, and that we will remit consumer’s use tax on the materials withdrawn from our inventory that will be annexed into real estate.
Our Nebraska Sales or Consumer’s Use Tax Identification number is:


Any purchaser, or the agent thereof, or other person who completes this certificate for any purchase which is other than for resale, lease, or rental in the regular course of the purchaser’s business, or is not otherwise exempted from the sales and use tax under Sections 77-2701 through 77-27,135 of the Nebraska Revenue Act, as amended, shall in addition to any tax, interest, or penalty otherwise imposed, be subject to a penalty of $100.00 or ten times the tax, whichever amount is larger, for each instance of presentation and misuse. With regard to a blanket certificate, said penalty shall apply to each purchase made during the period the blanket certificate is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct and complete.



   Authorized Signature

   Title

   Date