Texas Agricultural Sales and Use Tax Exemption Certificate
Retailer Information
MEDINA ELECTRIC COOPERATIVE, INC.
PO BOX 370
HONDO, TX 78861-0370
Name of Purchaser:
Address:
City:
State:
ZIP Code:
*Phone Number:
*Email Address:
Ag/Timber Number:
Exemption on File:
Please list the name of the person to whom the number is registered, if different than purchaser.
Person to whom number is registered:
*This certificate expires on Dec. 31, 20:
Customer Number:



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