Resale Number

                                                                                  CONCORD                                 The Better Choice                                       Import

3151 Fruitland Ave. Vernon California, 90058

Tel: (323) CON-CORD  Or  (323) 588-8888 Fax: (323) 588-2288


   Company Name:    ___________________________________Account#   ________________

    Contact Person:   _____________________________________________________________

            Address 1:    _____________________________________________________________

            Address 2:    _____________________________________________________________

                      City:   ______________________ State: _____________________Zip:   ________­­­­­­­­­­­­­_

               Country:   ______________________________________________________________

                      Tell: _________________________ Fax:__________________________________

                E-Mail : _______________________________________________________________

 Resale Number: _______________________________________________________________

I hereby certify, that I hold the above valid seller's permit number which issued pursuant to the sales and use tax law, that I am engaged in the business of selling general merchandise that the tangible personal property described herein which shall purchase from Concord Enterprises, Inc. will be resold by me in the form of tangible personal property provided, however that in the event of such property used for any purpose other than retention, demonstration or display while 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 tax, measure by the purchase price of such property. Description of property to be purchased: General Merchandise.


     Customer Signature: ______________________                        Date: ___/___/____


            Print the form fill it out sign it and fax it back to:  (323) 588-2288 Or email it back to: