Ellsworth Farmers Exchange Home Locations Services Market Center Weather About Us Forms Make a Payment Contact Account Access Tax Exemption Form Tax Exemption Form Business Name* Contact Name* First Last Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Primary Phone* Secondary Phone Email* Enter Email Confirm Email Account # Employer ID # The purchaser hereby claims exemption on the purchase of tangible personal property and selected services made under this certificate from the Ellsworth Farmers Exchange. This certificate is invalid unless all four sections have been completed by the purchaser. I understand and agree to this statement:* Yes No Section 1: Exemption is for:* One Time Purchase Blanket Certificate* (Recurring Business Relationship) Blanket Certificate* (maximum of 4 years) Section 2: Items covered by this certificate:* All Items Purchased Limited to the items listed below Exemption limited to the following items: Section 3: Basis for exemption claim:* Resale Agricultural Production Industrial Processing Non-Profit Organization Other Section 4: Certification In the event this claim is disallowed, the purchaser promises to reimburse the seller for the amount of the tax involved. I understand and agree with this statement: Yes No Expiration date (if less than three years):* A blanket certificate is valid for three years from the date of filling out this form unless an earlier expiration date is stipulated below. Untitled First Choice Second Choice Third Choice Customer Login Contact Us 877-885-0095 contact@ellsworthco-op.com Main Office & Ellsworth Energy Services, LLC 6509 Center St. PO Box 98 Ellsworth, MI 49729 Contact Us 877-885-0095 contact@ellsworthco-op.com Main Office & Ellsworth Energy Services, LLC 6509 Center St. Ellsworth, MI 49729 Home Make a Payment Locations Forms Contact Us Please Note: This web site contains links to other sites: Please be aware that we are not responsible for the content or privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of any other site that collects personally identifiable information. Copyright © 2021 Ellsworth Farmers Exchange. All rights reserved. Theme Spacious by ThemeGrill. Powered by: WordPress.