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Person to contact regarding payment or financial matters; _____________________________________________________________________
_________________________________________________________________________________
Title Telephone Fax
Sales Tax Exempt: ____ Yes ____ No
If you are Exempt from Tax. Please provide a copy of your Resale Certificate or other Exemption Certificate
Check box if purchases will be made with credit cards. (Do not complete Trade Credit Reference section.)
L-3 Communications accepts the following credit cards: Each transaction must identify CardHolder, Card Number and
Expiration Date
VISA MASTER CARD DISCOVER AMERICAN EXPRESS
Trade Credit References (include your primary bank):
1._________________________________________________________________________________________________________________________
2._________________________________________________________________________________________________________________________
3._________________________________________________________________________________________________________________________
ENCLOSE A COPY OF YOUR LATEST FINANCIAL STATEMENT
I/WE WARRANT THE INFORMATION SHOWN ABOVE TO BE TRUE. I/WE AUTHORIZE THE PERSON TO WHOM THIS APPLICATION IS
SUBMITTED TO INVESTIGATE THE REFERENCES HEREIN. STATEMENTS, OR OTHER DATA OBTAINED FROM ME/US OR FROM ANY OTHER
PERSON PERTAINING TO MY/OUR CREDIT AND FINANCIAL RESPONSIBILITY. I/WE UNDERSTAND ALL COSTS ASSOCIATED WITH
COLLECTING PAST DUE ACCOUNT BALANCES INCLUDING COLLECTION AGENCY FEES, IF APPLICABLE, SHALL BE BORNE BY THE
PURCHASER.
Signature Title Date
Type or Print Name of Person Signing _________________________________________________________________________________________________________
Please Return Form by Fax to: 602-436-1252 ATTN: CUSTOMER MASTER FILES
L-3 Communications, Aviation Communications and Surveillance Systems, ATTN:
City State Zip Code, Postal Country
Page 19
UNIFORM SALES AND USE TAX CERTIFICATE MULTIJURISDICTION
Issued to Seller: L-3 Communications
PO Box 21111
M/S H16A5
Phoenix, AZ 85036-1111
I HEREBY CERTIFY THAT:
Name of Firm (Buyer): _______________________________________________ is engaged as a registered: _____
- Common Carrier _____
Address: _______________________________________________ - Wholesaler _____
- Retailer _____
_______________________________________________ - Manufacturer _____
- Lessor _____
_______________________________________________ - Direct Pay _____
- Other (Specify) _____
and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale,
resale, ingredients or components of a new product to be resold, leased or rented in the normal course of our business. We are in the business of
wholesaling, retaining, manufacturing, leasing (renting) the following:
Description of Business: ___________________________________________________________________________________________
General description of products to be purchased from the seller: ___________________________________________________________
AL _______________________________________ MS _______________________________________
AZ _______________________________________ NE _______________________________________
AR _______________________________________ NV _______________________________________
CA _______________________________________ NJ _______________________________________
CO _______________________________________ NM _______________________________________
CT _______________________________________ NY _______________________________________
DC _______________________________________ NC _______________________________________
FL _______________________________________ ND _______________________________________
GA _______________________________________ OH _______________________________________
HI _______________________________________ OK _______________________________________
ID _______________________________________ PA _______________________________________
IL _______________________________________ RI _______________________________________
IN _______________________________________ SC _______________________________________
IA _______________________________________ SD _______________________________________
KS _______________________________________ TN _______________________________________
KY _______________________________________ TX _______________________________________
LA _______________________________________ UT _______________________________________
ME _______________________________________ VT _______________________________________
MD _______________________________________ VA _______________________________________
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