Attn: Liz McGillivray

Subsidiary of
Boss Manufacturing Company
Attention: Credit Manager
1221 Page Street
Kewanee, IL 61443
Phone # 800-959-2743 Fax # 847-247-2672

BLANKET EXEMPTION CERTIFICATE—SALES AND USE TAX

__________________________________________
Insert Name of City, County, and State
Date:__________________

This is to certify that I hold the valid seller permit listed below issued pursuant to the Sales and
use Tax Law, that we are engaged in the business of selling

___________________________________________________________________________

That the tangible personal property described herein, which we shall purchase from
Aries Manufacturing, a division of Boss Tech Products, Inc. will be resold by me for the
following purposes:

( ) Resale as tangible personal property

( ) To be incorporated as a physical component part of other tangible

personal property to be sold by the undersigned.

( ) Other (Specify)

Provided, however, that in the event any of such property is used for any purpose other than
retention, demonstration or display while holding it for sale in the regular course of business, it is
understood that the buyer/purchaser is required by the Sales and Use Tax Law to report and pay
for the tax, measured by the purchase price of such property.

Description of property to be purchased __________________________________________.

________________________________ _____________________________
Purchaser (Company Name) Seller’s Permit Number

________________________________ _____________________________
Address Signature

________________________________ _____________________________
City, State, and Zip Code Print Name and Title
Attn: Liz McGillivray
Boss Use Only

Boss Manufacturing Company Slsm _______________ CL _______________

Attn: Credit Manager
1221 Page Street Acct # ______________ Subs/Div __________
Kewanee Illinois 61443
Phone: (800) 959-2743 Fax: (847) 247-2672
This information is for credit use only and will be held in the strictest confidence.

__________________________________________________________________________________________________
Company Name Type of Business Phone Number

____________________________________________________________________________________________________________
Address Years in Business Fax Number

____________________________________________________________________________________________________________
City State Zip Avg amt expected to buy from Boss monthly.

Type of Ownership: _____ Corporation , _____ Partnership , _____ Proprietorship , _____ Government , _____ Non-Profit Org
Corp Fed ID# ______________ or if Proprietor, SS# ________________ Trade Name______________________________________

If a division or branch, parent’s name is: __________________________________________________________________________

Parent Co. Address__________________________________________________________________ Sales Tax Exempt? Yes No

___________________________________________________________________________________________________________
Principal Owner(s) or Officer(s) Resident Address(es) Phone Number

Please provide us with a copy of your latest audited financial statement.

Bank Reference______________________________________________________________________________________________
Name Phone Number Fax Number

1. _______________________________________________________________________________________________________
Address City State Zip

_______________________________________________________________________________________________________
Account Number Contact Person
References – Open Accounts – Complete Addresses

2. _______________________________________________________________________________________________________
Name Phone Number Fax Number

_______________________________________________________________________________________________________
Address City State Zip

3. _______________________________________________________________________________________________________
Name Phone Number Fax Number

_______________________________________________________________________________________________________
Address City State Zip

4. _______________________________________________________________________________________________________
Name Phone Number Fax Number

_______________________________________________________________________________________________________
Address City State Zip

5. _______________________________________________________________________________________________________
Name Phone Number Fax Number

_______________________________________________________________________________________________________
Address City State Zip

Continued on next page Form AD644-10

 Boss Manufacturing Company Attn: Liz McGillivray
and Subsidiaries
Credit Agreement
Terms and Conditions

Liability: Personal liability is assumed for owners or partners or proprietorships or partnerships, until notice of incorporation,
ownership change, or disbandment is received by BOSS.

Past Due Accounts: BOSS reserves the right to charge 1.5% per month as a service charge on overdue accounts and unpaid
balances or 18% per annum, but not to exceed the maximum amount permitted by applicable state law.

Cost of Collection and Attorneys Fees: If Buyer fails to pay any amount when due, including service charges, Buyer agrees to
pay the full amount of any cost or expenses, including reasonable attorney’s fees incurred by BOSS, in the
collection of such overdue amounts by litigation or otherwise.

Sales Tax: If you are tax exempt, please send a completed tax exemption certificate (use form enclosed).

Timely Notification: No shipping or delivery claims will be accepted unless made within 10 days after receipt of merchandise.
All Buyer claims resulting from incorrect invoicing must be submitted to Boss in writing within 60 days of invoice
date, or Buyer agrees to accept invoice as billed. BOSS will not make adjustments for claims after 60 days from
invoice date.

Payment Terms: Payment terms are stated on each invoice and are effective from invoice date. Any dispute of these terms must
be received by BOSS within 10 days of invoice.

Returned Checks: Buyer agrees to reimburse BOSS for any charges incurred to BOSS as the result of any protested checks
returned by your bank, and for any fees or cost incurred by BOSS to collect the face value of said checks (in states
where allowed by law).

Authority of Parties: No soliciting agent, sales representative or employee of BOSS shall have the power to waive any of the
terms or provisions hereof, or to incur additional obligations, or to make additional representatives or warranties on
behalf of BOSS unless same are evidenced by an agreement, in writing, signed by a duly authorized officer of
BOSS or the Credit Manager. Signer for Buyer represents that he is a duly authorized agent for Buyer, empowered
to sign this document and that the information supplied on the Credit Agreement form is true and accurate.

Governing Law: This agreement shall be governed by the laws of the state of Illinois.

Conditions: The account established hereunder and the credit extended hereby shall not be effective until this application is
accepted by BOSS in Kewanee Illinois. Buyer represents that this account is for business use only and that Buyer
will not purchase products from BOSS hereunder for personal, family, agricultural or household use.

I have read and agree to the terms and conditions listed above and authorize BOSS the right to contact and
investigate the bank and credit references provided.

Date: ____________________ Authorized Signer (Signature): ______________________________________________

Printed Name of Signer: ___________________________________________________

Title of Signer: __________________________________________________________

Company Name: _________________________________________________________