100 Jericho Quadrangle, Suite 140 | Jericho, NY 11753 | P. 212 273 9463 x 2401 | F. 516 677 0497 | skurnik.com
Dear New Customer,
Thank you for giving Skurnik Wines & Spirits the opportunity to serve your beverage needs.
We are excited to begin working with you!
In order to become our customer, we kindly ask that you complete the attached Account Profile
and Sales & Use Tax Unit Exemption Certificate. These are fillable PDFs that can be completed on
your computer. We are required by law to have your ABC License Number and The Exemption
Certificate which indicates that you are purchasing for resale and therefore we do not need to
charge you sales tax.
Please send completed forms to ar-creditapps@skurnik.com so that we may get you set up for
your first order.
If you use Fintech’s paid platform, please go to fintech.com and find us.
Should you have any questions, please do not hesitate to contact us at 212-273-9463 x 2401.
We look forward to working with you!
Sincerely,
Credit & Collections Team
Skurnik Wines & Spirits
100 Jericho Quadrangle, Suite 140 | Jericho, NY 11753 | P. 212 273 9463 x 2401 | F. 516 677 0497 | skurnik.com
ACCOUNT PROFILE
date license (corp) name
DBA (hereafter known as ‘buyer’)
license # expiration date Federal ID / resale #
street address city / state / zip
corp. start date requested credit limit delivery instructions
PRIMARY CONTACT (BUYER)
name title salesperson
business phone # cell # email
A/P CONTACT
name title fax #
business phone # cell # email
PRINCIPAL / PARTNER
name phone # social security #
home street address city / state / zip
ADDITIONAL PRINCIPAL(S) / PARTNER(S)
name phone # social security #
home street address city / state / zip
list additional corporations of partnerships
BANK REFERENCE
name address account # date account opened
TRADE REFERENCES
list at least two industry-related references
Hereafter known as the buyer, in consideration of obtaining purchases on credit from Skurnik Wines, Inc., 100 Jericho Quadrangle, Suite 140, Jericho NY 11753 (212) 273 9463 hereinafter known as the seller, does
hereby agree to the following: buyer agrees to honor all terms and conditions of most current price list, and assumes all responsibility for attainment of said information. Buyer also agrees to pay for interest at _____%
per month on any invoice that remains unpaid for more than _____ days after it is due, from the due date, and for any and all deliveries under and pursuant to its accounts whether ordered by the customer or by
any person representing himself/herself/itself to be an agent, employee or representative of the customer. The below signed agrees to personally guarantee all indebtedness owed to Skurnik Wines, Inc. by the buyer.
This guarantee shall be construed as an absolute and unconditional guarantee of payment, without regard to the validity, regularity or enforceability of any obligation of buyer. Creditor shall have its remedy under
this guarantee without being obligated to resort first to any security or to any other remedy or remedies to enforce the payment or collection of the said liabilities and may pursue all or any of its remedies at one time
or at different times. If this application is executed by a corporation, it includes any and all successor in interest of said corporation and is binding on the same and all successors in interest, now and in the future.
In the event of any delinquency of any account, buyer agrees to pay all collection costs, attorney fees of 25% of the unpaid balance due, and court costs in the collection of said account. Buyer consents to the venue
and jurisdiction of any court located in Nassau County, NY. Buyer agrees that in the event the buyer issues a check which does not clear the collection process, a $30.00 fee shall be added to the buyer’s indebtedness.
print name of applicant signature date
NEW JERSEY
ACCOUNT PROFILE
I, the undersigned purchaser, have read and complied with the instructions and rules promulgated pursuant to the New Jersey Sales and Use
Tax Act with respect to the use of the Resale Certificate, and it is my belief that the seller named herein is not required to collect the sales or
use tax on the transaction or transactions covered by this Certificate. The undersigned purchaser hereby swears under the penalties for
perjury and false swearing that all of the information shown in this Certificate is true.
___________________________________________________________________________________
NAME OF PURCHASER* (as registered with the New Jersey Division of Taxation)
___________________________________________________________________________________
(Address of Purchaser)*
___________________________________________________________________________________
Type of Business*
By
___________________________________________________________________________________
(Signature of owner, partner, officer of corporation, etc.)* (Title)
State of New Jersey
DIVISION OF TAXATION
SALES TAX
FORM ST-3
RESALE CERTIFICATE
To be completed by purchaser and given to and retained by seller. See instructions on back.
Seller should read and comply with the instructions given on both sides of an exemption certificate.
TO ________________________________________________________________________ Date _______________________________
(Name of Seller)
_______________________________________________________________________________________________________________
Address City State Zip
The seller must collect the tax on a
sale of taxable property or services
unless the purchaser gives him a fully
completed New Jersey exemption
certificate.
The undersigned certifies that:
(1) He holds a valid Certificate of Authority (number shown above) to collect State of New Jersey Sales and Use Tax.
(2) He is principally engaged in the sale of (indicate nature of merchandise or service sold):
________________________________________________________________________________________
________________________________________________________________________________________
(3) The merchandise or services being herein purchased are described as follows:
________________________________________________________________________________________
________________________________________________________________________________________
(4) The merchandise described in (3) above is being purchased: (check one or more of the blocks which apply)
(a) For resale in its present form.
(b) For resale as converted into or as a component part of a product produced by the undersigned.
(c) For use in the performance of a taxable service on personal property, where the property which is the
subject of this Certificate becomes part of the property being serviced or is later transferred to the
purchaser of the service in conjunction with the performance of the service.
(5) The services described in (3) above are being purchased: (check the block which applies)
(a) By a seller who will either collect the tax or will resell the services.
(b) To be performed on personal property held for sale.
MAY BE REPRODUCED
(Front & Back Required)
ST-3 (11-11, R-12)
PURCHASER’S NEW JERSEY
TAXPAYER REGISTRATION NUMBER*
*Required
INSTRUCTIONS FOR USE OF RESALE CERTIFICATES - ST-3
1. Registered sellers who accept fully completed exemption certificates within 90 days subsequent to the date of sale are relieved of
liability for the collection and payment of sales tax on the transactions covered by the exemption certificate. The following
information must be obtained from a purchaser in order for the exemption certificate to be fully completed:
Purchasers name and address;
Type of business;
Reasons(s) for exemption;
Purchasers New Jersey tax identification number or, for a purchaser that is not registered in New Jersey, the
Federal employer identification number or out-of-State registration number. Individual purchasers must
include their drivers license number;
If a paper exemption certificate is used (including fax), the signature of the purchaser.
The sellers name and address are not required and are not considered when determining if an exemption certificate is fully completed.
A seller that enters data elements from paper into an electronic format is not required to retain the paper exemption certificate.
The seller may, therefore, accept this certificate as a basis for exempting sales to the signatory purchaser and is relieved
of liability even if it is determined that the purchaser improperly claimed the exemption. If it is determined that the
purchaser improperly claimed an exemption, the purchaser will be held liable for the nonpayment of the tax.
2. Retention of Certificates - Certificates must be retained by the seller for a period of not less than four years from the date of the
last sale covered by the certificate. Certificates must be in the physical possession of the seller and available for inspection.
3. Acceptance of an exemption certificate in an audit situation – On and after October 1, 2011, if the seller either has not obtained
an exemption certificate or the seller has obtained an incomplete exemption certificate, the seller has at least 120 days after the
Division’s request for substantiation of the claimed exemption to either:
1. Obtain a fully completed exemption certificate from the purchaser, taken in good faith, which,
in an audit situation, means that the seller obtain a certificate claiming an exemption that:
(a) was statutorily available on the date of the transaction, and
(b) could be applicable to the item being purchased, and
(c) is reasonable for the purchasers type of business; OR
2. Obtain other information establishing that the transaction was not subject to the tax.
If the seller obtains this information, the seller is relieved of any liability for the tax on the transaction unless it is discovered
through the audit process that the seller had knowledge or had reason to know at the time such information was provided that the
information relating to the exemption claimed was materially false or the seller otherwise knowingly participated in activity
intended to purposefully evade the tax that is properly due on the transaction. The burden is on the Division to establish that the
seller had knowledge or had reason to know at the time the information was provided that the information was materially false.
4. Additional Purchases by Same Purchaser - This certificate will serve to cover additional purchases by the same purchaser of the
same general type of property. However, each subsequent sales slip or purchase invoice based on this Certificate must show the
purchasers name, address and New Jersey, Federal, or out of state registration number for purpose of verification.
5. Retention of Certificates - Certificates must be retained by the seller for a period of not less than four years from the date of the last
sale covered by the certificate. Certificates must be in the physical possession of the seller and available for inspection on or before
the 90th day following the date of the transaction to which the certificate relates.
EXAMPLES OF PROPER USE OF RESALE CERTIFICATE
a. A retail household appliance store owner issues a Resale Certificate when purchasing household appliances from a supplier for resale.
b. A furniture manufacturer issues a Resale Certificate to cover the purchase of lumber to be used in manufacturing furniture for sale.
c. An automobile service station operator issues a Resale Certificate to cover the purchase of auto parts to be used in repairing customer cars.
EXAMPLES OF IMPROPER USE OF RESALE CERTIFICATE
In the examples below, the seller should not accept Resale Certificates, but should insist upon payment of the sales tax.
a. A lumber dealer can not accept a Resale Certificate from a tire dealer who is purchasing lumber for use in altering his premises.
b. A distributor may not issue a Resale Certificate on purchases of cleaning supplies and other materials for his own office maintenance,
even though he is in the business of distributing such supplies.
c. A retailer may not issue a Resale Certificate on purchases of office equipment for his own use, even though he is in the business of selling
office equipment.
d. A supplier can not accept a Resale Certificate from a service station owner who purchases tools and testing equipment for use in his
business.
REPRODUCTION OF RESALE CERTIFICATE FORMS: Private reproduction of both sides of Resale Certificates may be made without the
prior permission of the Division of Taxation.
FOR MORE INFORMATION: Call the Customer Service Center (609) 292-6400. Send an e-mail to: nj.taxation@treas.state.nj.us
.
Write to: New Jersey Division of Taxation, Information and Publications Branch, PO Box 281, Trenton, NJ 08695-0281.