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New Customer Account Form
Facility Type (must check one):
If Entity is taxable but Product is not Taxable, please provide a State Tax Exempt Form supporting Exempt Product (Please consult with your Internal Tax Department or Advisors).
Upload Tax Exempt Certificate
If no, provide your State Tax Exempt Number and Exempt Certificate.
For Internal Use Only - CIT Ortho
*NOTE: IF HOSPITAL IS TAX EXEMPT, A COPY OF THE TAX EXEMPTION CERTIFICATE OR LETTER MUST BE FAXED TO CIT ORTHO. AN IRS 501c3 LETTER MAY NOT BE SUFFICIENT TO SUPPORT EXEMPTION.
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This information/document is confidential and proprietary. It may not be reproduced, used or disclosed to others without written consent of CIT Ortho.
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