Purchaser hereby certifies to Seller, Alken-Murray Corporation:

1. Purchaser holds a valid Registration or Permit Number issued under the Retail Sales Tax Act of the State or City of .

2. Certificate type: BlanketSingle Purchase

3. Tangible personal property purchased on each order is purchased for the following purposes:

• Resale in its present form.
• Resale as a component part of manufactured finished product.
• To be exported for sale, use, or consumption outside of the continental United States.
• Other (describe and attach a copy of certificate):

Note: Regulations require that certificates contain registration number, address and signature to be effective.

4. General description of products to be purchased from the seller

• Microbiological waste treatment
• Fuel additives
• Industrial water treatment chemicals

5. The undersigned purchaser further certifies that he will assume liability for payment of the tax if he uses or consumes the property herein purchased in such a manner as to render the sale subject to tax.

Date: Purchaser's Customer ID:

(we will assign this number)

Company Name

Street Address:

City and State:

By: __________________________________________

Official Title.Sign on the Line Above