Wholesale Application

SELLER:

Liberation Press LLC

13009 Division St

Blue island, IL

60406

PURCHASER BUSINESS NAME*

Contact Name*

First Last

Email*

Phone Number*

Area CodePhone Number

PURCHASER BUSINESS ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Complete the information by selecting only one box*

The purchaser is registered as a retailer with the Illinois Department of Revenue. *Account ID number must be filled below.The purchaser is registered as a reseller with the Illinois Department of Revenue. *Resale number must be filled below.The purchaser is authorized to do business out-of-state and will resell and deliver property only to purchasers located outside the state of Illinois.

Account ID or Resale #*

Upload a copy of your resale license*

Upload a File

PROPERTY BEING PURCHASED FOR RESALE:

Human & Pet Apparel

Complete the information by selecting one box only.*

I am the identified purchaser, and I certify that all of the purchases that I make from this seller are for resale.I am the identified purchaser, and I certify that the percentage listed below of all of the purchases that I make from this seller are for resale.

Percentage %

Purchaser’s signature & *date required. I certify that I am purchasing the property described in Step 3 from the stated seller for the purpose of resale.*