Blanket Certificate of Exemption

            The undersigned hereby claims exemption to purchases of tangible personal property from

_______________ H.E. Long Company _______________________

(name of vendor)

on and after _________________________________________ and certifies that this claim is based


upon the purchaser's proposed use of the item purchased, the activity of this purchaser, or both as

shown hereon:




(purchaser must state statutory reason for claiming exemption or exception)


This certificate shall continue until revoked and shall be considered a part of each order given to the

vendor stated above unless the order specifies otherwise.


                                    Purchaser's name                                                               ___________________________________________________


                                    Purchaser's Activity,                                                                         ________________________________________

i.e. Manufacturer, Distributor, etc            

Purchaser's Street Address                                                       ___________________________________________________

City, State Zip                                                                                                          ___________________________________________________         

                                                Tax I.D. License Number                                                                         ___________________________________________________                                         

                                                Signature and Date                                                                                                 ___________________________________________________