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    Resale Certificate Request Form

    Property Information

    Address:
    City:
    Zip:

    Current Owner(s):

    Requesting Entity

    Name:
    Entity:
    Address:
    Email:
    Telephone Number:

    Delivery Information

    How should FCCSA deliver the Resale Certificate? (one must be selected below)
    *FCCSA will provide within seven(7) to ten(10) business days of receipt of request and fee

    **Other Address:

    $100.00 Fee Must Accompany this Request in Order for FCCSA to Process

    Certificate of Compliance will also be provided- $125.00 Fee Charged at Closing

    See FCCSA Schedule of Fees (Effective February 2016)

    Credit Card:
    Transaction Fee: $2.95
    Amount:
    Card Number:
    Exp Date:
    Name:
    Security Code:
    Address:
    Date of Birth:
    Email:
    Phone:
    Signature:
    Date: