3747 Hecktown Rd.

Easton, PA 18045
(610) 250 2099 or 1 (800) 451 - 2817
Fax 1 (866) 804 - 0616

CUSTOMER APPLICATION INSTRUCTIONS: Please answer ALL questions listed below. Federal Tax I.D. numbers are required information. If a question does not pertain to your company or you
individually, please mark the answer 'N/A'. The customer has the obligation to notify Phillips Pet Food & Supplies in writing as to any changes of the information supplied herein. Please read the
important information listed on the bottom of this APPLICATION before signing. Please fill out the information regarding the ownership of your Company.

BASIC INFORMATION

NAME OF COMPANY: Symbiosystec Inc. *COMPANY IS TAX EXEMPT: Yes

TRADING AS: Symbiosystec Inc. TAX EXEMPT CERTIFICATE ID: 842232306

WEBSITE: http://symbiosystec.com/ TAX EXEMPT STATE:

Illinois - IL

RELATED ACCOUNT LOCATION: 1045 Arbor CT, Mount Prospect, IL EXPIRATION DATE: 8/1/2023

CURRENT DISTRIBUTORS:
Kehe UPLOAD TAX EXEMPT FORM:

*IF TAX EXEMPT, TAX EXEMPT CERTIFICATE IS REQUIRED.

CONTACT INFORMATION

APPLICANT CONTACT

APPLICANT FIRST NAME:

Alex APPLICANT LAST NAME:
Ray

APPLICANT TITLE: Sales Manager APPLICANT EMAIL: alex@symbiosystec.com

MARKETING EMAIL: alex@symbiosystec.com

BILLING CONTACT

BILLING FIRST NAME: Alex BILLING LAST NAME: Ray

BILLING PHONE: 8476772771 BILLING MOBILE:

BILLING STREET ADDRESS: 1045 Arbor CT, Mount Prospect, IL

BILLING CITY:
Mount Prospect BILLING STATE:
Illinois - IL BILLING ZIP:
60056

SHIPPING CONTACT SHIPPING ADDRESS IS SAME AS BILLING ✔

SHIPPING CONTACT FIRST NAME: SHIPPING CONTACT LAST NAME:

SHIPPING PHONE NUMBER: SHIPPING EMAIL:

SHIPPING STREET ADDRESS:

SHIPPING CITY: SHIPPING STATE: SHIPPING ZIP:

OWNERSHIP CONTACT OWNERSHIP ADDRESS IS SAME AS BILLING

BELOW - PLEASE FILL OUT THE INFORMATION REGARDING THE OWNERSHIP OF YOUR COMPANY. IF THERE ARE ADDITIONAL OWNERS,
PLEASE ATTACH A SEPARATE SHEET WITH A LIST OF THE ADDITIONAL OWNERS. IF PARTNERSHIP, PLEASE INCLUDE ALL GENERAL PARTNERS.

OWNER FIRST NAME: Abbas OWNER LAST NAME: Raza

OWNER TITLE: Owner OWNER PHONE NUMBER: 8476772771

OWNER ADDRESS:
1045 Arbor CT, Mount Prospect, IL

OWNER CITY: Mount Prospect OWNER STATE: Illinois - IL OWNER ZIP: 60056

*ADDITIONAL OWNERS:
N/A
*IF PARTNERSHIP, PLEASE INCLUDE ALL GENERAL PARTNERS.

TRANSPORTATION INFORMATION

LOCATION TYPE: Residential DOC HEIGHT: 9.5 FT

DELIVERY LOCATION:
Front STEPS OR STAIRS:
zero

RECEIVING HOURS:
9 am to 5 pm CDT STORE HOURS:
9 am to 5 pm CDT

COMMERCIAL PARKING RESTRICTIONS IN PLACE DELIVERY NEEDS TO BE BROUGHT INSIDE

LOCATION CAN ACCOMMODATE 48’ TRAILER ✔ LOCATION HAS RECEIVING DOC

PREFERRED DELIVERY DAYS* ✔ MONDAY ✔ TUESDAY ✔ WEDNESDAY ✔ THURSDAY ✔ FRIDAY

*REQUESTED DELIVERY DATES CANNOT ALWAYS BE ACCOMMODATED, AND ARE SUBJECT TO CHANGE

SALES INFORMATION:

METHOD OF ORDERING: Email WEBSITE ACCESS NEEDED? Yes

BUSINESS STRUCTURE: Ecommerce DELIVERY LOCATION TYPE:

Non-retail Location

PRIMARY BUSINESS TYPE: Standard Ecommerce Yes

CAN CUSTOMER ORDER ONLINE?

ANNUAL SALES:
5,000,000 NO. OF EMPLOYEES:
25

DATED OPENED:
June 2018 SQUARE FOOTAGE:
N/A

SERVICES OFFERED: PRODUCTS OFFERED:

AQUARIUM MAINTENANCE GROOMING AQUATICS AND REPTILES LITTER

BOARDING LIVE ANIMAL SALES BIRD AND SMALL ANIMAL ✔ SUPPLIES

DAYCARE MEDICAL ✔ DOG AND CAT FOOD TREATS

DOG WALKING RESCUE ✔ LAWN AND GARDEN

✔ FOOD SERVICES TRAINING

SIGNATURE

COMPANY NAME Symbiosystec Inc.

Alex Ray PLEASE UPLOAD YOUR

SIGNATURE Alex Ray (Jun 2, 2023 00:15 GMT+5)
DATE Jun 2, 2023 RETAILER CERTIFICATE HERE

All application information presented is warranted to be true. I/We hereby authorize Phillips Feed Service, Inc., its assigns and successors (PFS) as their interest may appear to investigate my/our credit worthiness and financial responsibility. The undersigned represents
that he/she is the owner/managing member/financially responsible party who unconditionally & personally guarantees payment of all invoices within the stated terms both for the corporation and individually. All invoice(s) are due pursuant to the terms explicitly
stated on the invoice(s) and in the event of default the undersigned agrees to pay all finance charges at the PFS’ prevailing rate until the balance is paid in full, costs of collection and/or reasonable attorney’s fees. Nonpayment or continued slow payment of invoices
or finance charges will be cause, at the discretion of PFS, for the account’s suspension resulting in termination of ordering privileges. Suspension/termination of ordering privileges will not in any way relieve the undersigned guarantor’s obligation to pay all accrued
amounts due. PFS reserves the right to change the account’s terms & conditions at its sole discretion. In the event the business is sold or legal ownership otherwise changes, the undersigned shall immediately inform PFS in writing and identify the successors contact
information as well as all attorney’s information prior to the change officially taking effect.
 Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue

CRT-61 Certificate of Resale

Step 1: Identify the seller Step 3: Describe the property
1 Name Phillips Pet Food & Supplies
__________________________________________ 6 Describe the property that is being purchased for resale or
list the invoice number and the date of purchase.
2 Business address 3747 Hecktown Rd
_________________________________ _______________________________________________

Easton PA 18045
_______________________________________________ _______________________________________________
City State Zip

_______________________________________________
Step 2: Identify the purchaser
Step 4: Complete for blanket certificates
3 Name Symbiosystec INC
__________________________________________
7 Complete the information below. Check only one box.
4 Business address 1045 Arbor CT,
_________________________________ I am the identified purchaser, and I certify that all of the
purchases that I make from this seller are for resale.
Mount Prospect IL 60056
_______________________________________________
City State Zip
I am the identified purchaser, and I certify that the following
percentage, ______100 %, of all of the purchases that I make
5 Complete the information below. Check only one box.
from this seller are for resale.
The purchaser is registered as a retailer with the Illinois
Department of Revenue. __ __ __ __ - __ __ __ __ .
Account ID number
Step 5: Purchaser’s signature
I certify that I am purchasing the property described in Step 3
The purchaser is registered as a reseller with the Illinois
from the stated seller for the purpose of resale.
Department of Revenue. 4 __
__ 3 __
2 __
7 - __7 __
7 __
2 __
1 .
Resale number
The purchaser is authorized to do business out-of-state and
_____
Purchas
Alex Ray _ 05/04/2023
_/_ _/_ _ _ _
_____________________________
Date
will resell and deliver property only to purchasers located
outside the state of Illinois. See Line 5 instructions. Reset Print
Note: It is the seller’s responsibility to verify that the When is a blanket certificate of resale used?
purchaser’s Illinois account ID or Illinois resale number is The purchaser may provide a blanket certificate of resale to
valid and active. You can confirm this by visiting our web site any seller from whom all purchases made are sales for resale.
at tax.illinois.gov and using the Verify a Registered Business A blanket certificate can also specify that a percentage of the
purchases made from the identified seller will be for resale. In
tool.
either instance, blanket certificates should be kept up-to-date.
General information If a specified percentage changes, a new certificate should be
provided. Otherwise, all certificates should be updated at least
When is a Certificate of Resale required? every three years.
Generally, a Certificate of Resale is required for proof that no tax
is due on any sale that is made tax-free as a sale for resale. The Specific instructions
purchaser, at the seller’s request, must provide the information
that is needed to complete this certificate. Step 1: Identify the seller
Lines 1 and 2 Write the seller’s name and mailing address.
Who keeps the Certificate of Resale?
The seller must keep the certificate. We may request it as proof Step 2: Identify the purchaser
that no tax was due on the sale of the specified property. Lines 3 and 4 Write the purchaser’s name and mailing address.
Do not mail the certificate to us. Line 5 Check the statement that applies to the purchaser’s
Can other forms be used? business, and provide any additional requested information.
Yes. You can use other forms or statements in place of this Note: A statement by the purchaser that property will be sold for
certificate but whatever you use as proof that a sale was made for resale will not be accepted by the department without supporting
resale must contain evidence (e.g., proof of out-of-state registration).
the seller’s name and address; Step 3: Describe the property
the purchaser’s name and address; Line 6 On the lines provided, briefly describe the tangible
a description of the property being purchased; personal property that was purchased for resale or list the invoice
a statement that the property is being purchased for resale; number and date of purchase.
the purchaser’s signature and date of signing; and
either an Illinois account ID number, an Illinois resale number, Step 4: Complete for blanket certificates
or a certification of resale to an out-of-state purchaser. Line 7 The purchaser must check the statement that applies,
Note: A purchase order signed by the purchaser may be used and provide any additional requested information.
as a Certificate of Resale if it contains all of the above required Step 5: Purchaser’s signature
information. The purchaser must sign and date the form.
CRT-61 (R-12/10)
IL-492-3850