Povia Paints | Become A Customer

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cash account form

Date

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Exemption Certificate #

Type of Business

Account Name

Contact Person

Street Address

City

State

Zip Code

Office

Cell

Fax

Estimated Monthly Purchases

Yes

Povia Representative or Store Location

Contact info:

Purchase order required:

tax exempt:

(A copy of certificate must be attached or faxed along with this application)