Free 01-136 Credit Memo Acceptance - Texas

01-136 (Rev.11-02/5)

CREDIT MEMO ACCEPTANCE
Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or toll-free number listed on this form.
Name of purchaser, firm or agency accepting credit memo

Address (Street address, P.O. Box or Route number)

Daytime phone (Area code & number)

City

State

ZIP code

I, as the authorized representative for the party named above, accept credit memo number ________________ dated _______________________ in the amount of $ _________________ . This credit memo was issued to us by ________________________________________________________ , our vendor, to cover sales or use tax collected from us on invoice number(s) _________________________________________________________ , by the vendor, dated ________________________________________________________________________ .

I understand that this credit memo is being issued in lieu of a cash refund from the vendor or the State of Texas and will be credited against my account. This credit memo is unqualifiedly accepted in full and final settlement of the refund due us for sales or use taxes regardless of any subsequent actions taken by the vendor in regard to it.

__________________________________________________
Print or type name

__________________________________________________
Relationship to Entity (i.e., President, Treasurer)

__________________________________________________
Signature

__________________________________________________
Date

For detailed refund request instructions, please refer to Pub. How to Get a Refund or Credit for Sales or Use Tax You Paid in Error, or call the Sales Tax Refunds Verification Section at the State Comptroller's office at 1-800-531-5441, extension 3-4545. The Austin number is 512/463-4545. If you're calling from a Telecommunications Device for the Deaf (TDD), the toll-free number is 1-800-248-4099, or in Austin, 512/463-4621. You may also e-mail us at [email protected].