For more information see To Wholesale Dealers and Manufacturers. Instructions: Please complete and submit the following form. ALL FIELDS MUST BE COMPLETED. You will receive by return e-mail (almost immediately) a form with this information included in the appropriate places. Just print, date, sign and fax it to us at our fax number (which will be shown on the e-mail). You will also receive access to our wholesale price list.

	Company Name:
	Purchaser (contact):		Title:
	Street Address:
	City/State/ZIP:

I HEREBY CERTIFY: That I hold valid seller's permit No: issued pursuant to the Sales and Use Tax laws that I am engaged in the business of selling: that the tangible personal property described herein which I shall purchase from Roland's of California, will be resold by me in the form of tangible personal property: provided, however in the event any such property is used for any purpose other than intention, demonstration or display while holding it for sale in the regular course of business, it is understood that I am required by Sales and Use Tax Law to report and pay tax measured by the purchase price of such property or other authorized amount. Description of property to be purchased: