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Fairbank Equipment, Inc. www.fairbankequipment.com S381 BREAKDOWNSI understand that the information provided on this form is not an application for credit, but is provided to keep address, phone, and sales tax information on file with Fairbank Equipment, Inc. In addition, it will allow Fairbank Equipment, Inc. to keep purchase history on file for future reference. All merchandise must be paid for at time of purchase.Please FILL OUT, SIGN, and then FAX this form to 1-800-685-9202.FARM NAME:UPS/DELIVERY ADDRESS:MAILING ADDRESS:CITY: STATE: ZIP CODE:PHONE#: CELL: FAX: EMAIL:PRINCIPAL OWNER(S):Agricultural Exemption Certificate -Not Applicable in NebraskaThe undersigned purchaser certifies that the sale to him/her of tangible personal property or service by Fairbank Equipment, Inc. is exempt for sales and compensating use taxes in the state of: KS SD CO MO TX OK/SMX#: _______________________, Other: ______________ because the property purchased is one of the following:1. Farm or agriculture machinery or equipment. 2. Farm or agriculture repair or replacement parts.3. Labor services on farm or agriculture machinery or equipment. *Items 1, 2, & 3 must be used exclusively in farming, ranching, or agriculture.Description of tangible personal property or services provided: ______________________________________________________________________________________________________________________________The undersigned understands and agrees that if the tangible personal property or services are used in a method other than which is stated above, or for any other purpose that is not exempt from sales or compensating use tax, the undersigned purchaser becomes liable for the tax debt.Date: _________________ Purchaser: ______________________________________________________Signature: ______________________________________________________________________________P.O. Box 13237, Wichita, Kansas 67213-0237Phone: 800-666-5764 www.fairbankequipment.com