Partner With Us

New Customer Information Sheet

New Customer Information Sheet

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
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Key Drop
Site Survey Completed
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Type
Customer Information
Address (Ship to)
Pricing Information
Special Pricing
My Product Listing
Routing/Shipping Information
Delivery Days
Deliver After
:
Deliver Before
:
Approvals
Sales
Clear Signature
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Accounting
Clear Signature
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Owner/GM
Clear Signature
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Application for Credit and New Account Information Form

Application for Credit and New Account Information Form

Request for Taxpayer Identification Number and Certification

Request for Taxpayer Identification Number and Certification

Transaction Privilege Tax Exemption Certificate

Transaction Privilege Tax Exemption Certificate
  • This field is for validation purposes and should be left unchanged.
    • Do not use Form 5000 to claim sale for resale. Use Form 5000A.
    • Do not use Form 5000 if you are a non-TPT licensed contractor. Use Form 5000M.
  • This Certificate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009. The purpose of the Certificate is to document and establish a basis for state and city tax deductions or exemptions. It is to be filled out completely by the purchaser and furnished to the vendor at the time of the sale. The vendor shall retain this Certificate for single transactions or for the specified period as indicated below. Incomplete Certificates are not considered to be accepted in good faith. Only one category of exemption may be claimed on a Certificate.

    A. Purchaser’s Name and Address:

  • B. Check Applicable Box:

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • (This certificate is required to be completed when events affecting qualification for an exemption or deduction claimed in this certificate changes. However, this certificate will be considered to be accepted in good faith if the person accepting this certificate has no knowledge of any event that has occurred that affects qualification for the exemption or deduction being claimed in the certificate.)
  • C. Choose one transaction type per Certificate:

  • D. Reason for Exemption:

    Check the box indicating one of the more common exemptions provided below, or use Box 16 or 17 to cite the appropriate authority for another exemption (deduction). Refer to TPT Deduction Codes for a complete list of state and city exemptions (deductions) and the business classes (codes) under which the deductions apply.

  • *Refer to TPT Deduction Codes for a complete list of state and city exemptions (deductions) and the business classes (codes) under which the deductions apply.

    E. Describe the tangible personal property or service purchased or leased and its use below. (Use additional pages if needed.)

  • F. Certification

    A vendor that has reason to believe that this Certificate is not accurate or complete will not be relieved of the burden of proving entitlement to the exemption. A vendor that accepts a Certificate in good faith will be relieved of the burden of proof and the purchaser may be required to establish the accuracy of the claimed exemption. If the purchaser cannot establish the accuracy and completeness of the information provided in the Certificate, the purchaser is liable for an amount equal to the transaction privilege tax, penalty and interest which the vendor would have been required to pay if the vendor had not accepted the Certificate. Misuse of this Certificate will subject the purchaser to payment of the amount equal to any tax, penalty or interest pursuant to A.R.S. § 42-5009. Willful misuse of this Certificate will subject the purchaser to criminal penalties of a felony pursuant to A.R.S. § 42-1127.

  • I, (print full name)

  • hereby certify that these transactions are exempt from Arizona transaction privilege tax and that the information on this Certificate is true, accurate and complete. Further, if purchasing or leasing as an agent or officer, I certify that I am authorized to execute this Certificate on behalf of the purchaser named above.

  • Clear Signature
  • MM slash DD slash YYYY

Credit Card Authorization Form

Credit Card Authorization Form
  • This field is for validation purposes and should be left unchanged.
  • This form authorizes payment by credit card for monetary transactions by Scottsdale Specialty Produce Company.
    This form may be faxed, mailed or delivered.
  • Credit Card Billing Information: (Please Print)

  • MM slash DD slash YYYY
  • Clear Signature
  • MM slash DD slash YYYY
  • Your completion of this authorization form will help us to protect you, our valued customer, from credit card fraud. Scottsdale Specialty produce Company will keep all credit card information confidential. There is 3.85% fee for this service.

    This agreement will stay in effect until it is changed or terminated by notifying us in writing, or the card noted on this document has expired. Once we have acted upon your notice, no further or pending transactions will be made