Purchaser's Name :                 Please enter your name.

Business Address :                 Enter your Business Address

City :                                        Enter your City

State :                                      Enter your State               Zip :     Enter your Zip

I herby certify that I hold a valid California seller's permit.
My permit number is :     Enter your Permit Number

Issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling:
;Enter your Retailer Tax ID that the tangible personal property
described herein which I shall purchase from BrillianteCrystalCleaner, 14852 Ventura Blvd. Suite 210
Sherman Oaks CA 91403, 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 tax,
measured by the purchase price of such property of other authorized amount.

Description of property purchased:   Enter Description of property purchased:

Name of Authorized Agent :                Enter Name of Authorized Agent

Agent Title.                                          Enter Agent Title :

Phone Number :                                   Enter your Phone Number

E-mail :                                                Please enter your e-mail address.Please enter your e-mail address.