Underwater World New Customer Request

Account Information

STORE Name: Date: //
If a Corporation, Enter Corporate Name:
Street Address (No P.O. Box):
City: State: Zip:
Country: How did you hear about us?:
Phone: Fax:


Manager: Business Since: Store Hrs: to
Size of Store (sq. ft.): Size of Saltwater System (gallons):
Shipping Account - Airport: Airline:
Home Street Address:
City: State: Zip:
Home Phone: Cell Phone:
Drivers Lic #: State:
California Store - Soc Sec #:
That I hold a valid seller's permit # issued pursuant to the Sales and Use Tax Law: that I am engaged in the business of selling LIVE TROPICAL FISH AND/OR AQUARIUM SUPPLIES that the tangible personal property described herein which I shall purchase from UNDERWATER WORLD ENTERPRISES will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, It is understood that I am required by the Sales and Use Tax Law to report and pay the tax, measured by the purchase price of such property. Property to be purchased: LIVE TROPICAL FISH AND/OR AQUARIUM SUPPLIES.
Dated: // By:
Title: Phone:
Upload a copy of your Resale Certificate (jpg or gif): (If you do not have a scanner, you may fax
your business license/resale permit to this fax number and we will upload it to your profile: 310-695-6734)