Commercial Job Information

7555 FM 762
Richmond, TX 77469

Date

Customer Name First Name Last Name

Job Name (Description)

Job Address

Address1

Address 2

City

State

Zip

Legal Description of Job

General Contractor

First Name Last Name

Phone #

Address1

Address 2

City

State

Zip

Owner of the above described property

First Name Last Name

Phone #

Address1

Address 2

City

State

Zip

Surety / Bonding Agent

Bond #

First Name Last Name

Phone #

Address1

Address 2

City

State

Zip

Is project tax exempt?

Yes

No

Estimated Yardage

Job Site Contact

First Name Last Name

Phone #

Address1

Address 2

City

State

Zip

Price

Mix Code/Description

Estimated Quantity

Price

Mix Code/Description

Estimated Quantity

Texas Sales and Use Tax Exemption Certification

This certificate does not require a number to be valid.

First Name Last Name

Phone #

Address1

Address 2

City

State

Zip

I, the purchaser named above, claim an exemption from payment of sales and use taxes (for the purchase of taxable items described below or on the attached order or invoice) from:

Seller

Address1

Address 2

City

State

Zip

Description of items to be purchased or on the attached order or invoice:

Purchaser claims this exemption for the following reason:

Submit

Commerical Job Information

To be completed for each job location or project